Academy of Chiropractic’s Lawyers PI Program

Compliance #2

From the Desk of :

“Audits - Audits - Audits”

Coming to you…VERY SOON!

For years I have been writing about how to prevent and/or survive audits. Today is where the “rubber meets the road” to see if you have been listening. The following was recently sent with the solutions to follow:

September 2014

HHS OIG Auditing Chiropractic Records; ACA Offers Help to Members

The ACA was recently notified that the Office of Inspector General (OIG)* is currently conducting a nationwide review of the chiropractic profession.  Doctors of chiropractic have received letters requesting records for services provided during calendar year 2013.

It is critical that all doctors of chiropractic who receives a letter from the OIG responds with the requested documentation and by the specified deadline.
We strongly recommend that doctors of chiropractic who receive an OIG record request consult with their personal attorney and also contact ACA via e-mail at so that we can provide essential information to help you navigate the OIG request process.**

Please contact ACA with any questions.
* The Office of Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) is the entity dedicated to identifying and combating fraud, waste and abuse and improving efficiency in Medicare, Medicaid and other HHS programs. 
**This is informational assistance only. ACA cannot be responsible for individual documentation requests or content, nor can ACA be responsible for any resulting liability and/or action taken by any regulatory authority. ACA's assistance is designed to provide authoritative information to help doctors of chiropractic comply with the OIG request. This assistance is provided with the understanding that the ACA is not engaged in rendering legal or other professional services. Doctors should always consult with their legal representative before responding to any regulatory agency request. 

As I have shared with you previously, the following suggestion is not just for Medicare, but how to document for every patient in your office, whether they are cash, personal injury or Medicare because I assure you that audits are here to stay as they are a “cash cow” for both the government and private entities alike. 

This past week I was contacted by a personal injury carrier that wanted to retain me to find patterns of fraud in a large group of chiropractors. They didn't say that I would be helping to rid the industry of fraud, they wanted me to find patterns of fraud.  In other words, look for nuances in order to create a legal windfall for the carriers at your expense. 

The solution is simple.

First… You SHALL re-evaluate your active care patients every 30 days, not every 12-14-9-19 visits like some of you erroneously think. This is in the federal register and no matter how smart you are…be prepared to get your checkbook out to write repayment checks and fines if you have not adhered to that policy. The only time you can deviate from that is with some state’s workers` compensation guidelines (or other mandatory guidelines) that specifically state every 45 days (or a different number).

Second… Treat only what has been diagnosed. This is a HARD rule and has been the cause for many doctors to lose at every level of audit, litigation and/or licensure review. The last doctor I represented as a compliance expert in a fraud charge from Encompass had to pay $755,000 in settlement and legal fees because he didn’t follow that simple rule although his documentation was otherwise outstanding. 

For every area touched, there must be a symptom, clinical finding and resultant diagnosis. The biggest issue in chiropractic is many areas are asymptomatic. For those areas, eliciting a symptom is clinically sound and documentable to support treating an area.

As an example, many of you treat full spine (like I do) and rarely will a patient complain of thoracic pain. Therefore when I conduct my clinical examination I will elicit a response (if clinically present) and document the elicited response to provide the symptom and clinical finding in 1 evaluation process. This is something taught in academia (you learned it in school) and it is an ethical, valid method of meeting that “box to be checked off” in an audit. 

Remember, an auditor simply has a sheet with boxes in it. Is there a diagnosis, clinical finding and complaint? You must get all the boxes checked off. 

Follow this simple procedure and sleep well… 

PS...My Grandson