Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 180

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

“Compliance Alert: Chiropractic is Targeted”

URGENT: Read the end notes
President Signs “Improper Payments Elimination” Bill

July 30th, 2010

President Obama signed the Improper Payments Elimination and Recovery Act (IPERA) July 22. The bill is designed to cut waste, fraud, and abuse due to improper payments by federal government agencies. Areas with a history of improper payments, such as chiropractic services, will be targeted.

In 2009, improper payments totaled nearly $110 billion—the highest amount to date. This includes tens of billions of dollars in payments made in error or because of fraudulent claims by contractors and organizations as well as more than $180 million in improper payments sent to individuals who are dead and $230 million in improper payments to prisoners and fugitives—none of whom qualify for benefits.

The president has instructed his administration to reduce these improper payments by $50 million by 2012 and to create a “Do Not Pay” list—a consolidated database of every individual and company that is ineligible for federal payments.

“Before checks are mailed, agencies will be required to check this list to make sure the payment is going to the right person, in the right amount, for the right reason,” President Obama said before signing the bill in the White House.

The bill outlines steps federal agencies will need to take to reduce and recover improper payments, including:

  • Identification and Estimation of Improper Payments. IPERA requires agencies to conduct annual risk assessments, and if a program is found to be susceptible to significant improper payments, then agencies must measure improper payments in that program. Further, over time, IPERA lowers the threshold for determining a program is susceptible to improper payments.
  • Payment Recapture Audits. The bill expands the types of programs that are required to conduct payment recovery audits (from contracts to all types of programs and activities, including grants, benefits, loans, and contract payments), and lowers the threshold for programs and activities that must conduct these reviews if cost-effective (from $500 million to $1 million in annual outlays).
  • Use of Recovered Improper Payments. IPERA also authorizes agency heads to use recovered funds for additional uses than currently allowed, including to improve their financial management, to support the agency’s Office of Inspector General (OIG), and for the original intent of the funding.
  • Compliance and Non-Compliance Requirements. Currently, if an agency does not reduce improper payments or implement the existing law, there are no repercussions. Under IPERA, there is a list of actions that an agency must take to be in compliance with the law, and the agency Inspector General is responsible for determining whether the agency is in compliance with the law. If the agency is found not to be in compliance with the law, then IPERA contains a series of actions that the agency must take to improve its error reduction efforts.

Chiropractors Targeted

According to WPS Medicare, chiropractic services fall within the list of four supplemental measures listed in the strategy developed by the federal government. Chiropractic physicians throughout the Medicare administrative contractor’s (MAC’s) jurisdiction 5 (Iowa, Kansas, Missouri, and Nebraska) will be part of the national review aimed at eliminating payment error, waste, fraud and abuse in federal programs.

Independent note: The following is a national focus

Beginning August 2010, Comprehensive Error Rate Testing (CERT) contractors will begin requesting records from chiropractic offices as part of a Special Studies request. Unlike traditional CERT requests, Special Studies requests use targeted samples, focused scripts and allow only 30 days for submission of requested medical records.

Other measures include those for power wheelchairs, inpatient hospital short stays, and pressure reducing support surfaces.

For additional information, refer to the Medicare Fee-for-Service portion of the Payment Accuracy website by clicking on “High Error Programs” at the top of the page.

The IPERA is available for viewing on The Library of Congress website.

For years I have been telling, writing and pleading with the chiropractic profession to make sure their records are in order. For those who have taken the advice and submitted to a self-voluntary (confidential) audit, 100% had serious areas of insufficient records that would have amounted to $100,000’s of fines, penalties and losing lawsuits. 
Just because the above scenario is Medicare, do not think you are immune if you do not accept Medicare. The managed care, personal injury and workers compensation providers are more aggressive because with private resources and no Federal oversight, they can and do so much more to you. 
As I have said before, it’s about the money and they want their money back. Just because you are a healer and provided an honest service, doesn’t mean that you are entitled to the money in their eyes. It’s not about what services you performed, it’s about what you have documented that matters and that is called verification.
Without compliant verification, you are not entitled to any money and you will lose any argument, battle, lawsuit or criminal prosecution. If you still use a travel card and are audited, be prepared to lose. If you do not keep full SOAP notes each visit, be prepared to lose. If you do not re-evaluate your patients in the prescribed manner defined by Medicare or your state regulatory agencies, be prepared to lose.
Go to: and learn more about compliance. 
I also urge you at the highest level to contact Dr. Michael Schonfeld, from the Academy of Chiropractic’s Compliance Auditing Division, at 516-695-7732 and talk to him about getting your charts audited. His $500 fee is less than 2 hours of retaining a health care lawyer to get you out of trouble. A health care lawyer will charge you 50-100 hours of time to resolve your issues, not get you out of trouble. Instead, he/she will cut a deal with a predatory carrier so you do not lose your license, all of your money or go to jail for fraud.
This is serious stuff. Please understand that I am not being inflammatory. In fact, I am not giving you the total picture. The last 10 doctors who called to explain the hell they have been living in, said they wished they could turn back the hands of time and heed my advice of getting a voluntary audit to fix their deficiencies. The average retrospective or prospective audit takes 2-3 years of legal battles to conclude and I do not know of one person who has walked away without paying significant money back to the payors with $10,000-$100,000 in additional legal fees.
For those of you in the Academy of Chiropractic’s Lawyers PI Program, make sure you use the SOAP notes template provided as a guide for your electronic records or to use exclusively for your visit encounters. Go to: content&view=article&id=296 to get the SOAP Note. Do it right from the beginning and never get there.

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