by Ray Foxworth, D.C., FICC, MCS-P
President & Founder, ChiroHealthUSA
For decades I have subscribed to the wisdom of President Ronald Reagan, “Trust, but verify.” Unfortunately, not enough docs around the country are verifying that the information they receive from consultants, management companies, DME suppliers, and others is accurate. They trust that what they are being told is accurate, and unfortunately, suffer the consequences for not verifying the information. In this day and age, there are numerous resources at our fingertips to verify information, from our state associations to Google.
In August, I ran across an article about a practice that is currently suffering from the consequences of “taking their word for it” and not doing their research. In April 2016, the practice owner contracted with a consulting company that assists chiropractors in developing additional sources of revenue. The company recommended they hire nurse practitioners and a medical director so the practice could bill private and public healthcare providers for services that a chiropractor alone could not.
The practice collected $1,434,798.45 in Medicare reimbursements by submitting false claims for the surgical implantation of neurostimulators and pulse generators while actually only installing an acupuncture device. The electric acupuncture device, called a P-Stim, requires only that wires from a small, wearable battery-powered device be attached to patient’s ears. The P-Stim can also easily be attached in an office setting. The P-Stim acupuncture devices cost just $300-$500, but Medicare paid $5,800 to $6,400 each time the practice billed under a code that actually applied to a neurostimulator device. The practice followed the consultant’s advice, and unwittingly used a billing code for the acupuncture device that was actually the code for the neurostimulator. When the error was discovered, the owner effectively blew the whistle on herself. The practice agreed to pay $4,304,692.35 in triple damages while the owner paid $700,000 in civil penalties. This article is not meant to disparage the vendors and suppliers in our profession. It is intended to highlight the importance of doing your homework! Box 31 on the claim form is YOUR attestation that the information is accurate, and if it isn’t accurate, it is YOUR name on the claim, not the vendors and YOUR fine. So again, Trust But Verify!
Unfortunately, this story is not an anomaly. These kinds of things happen every day. We are all looking for ways to grow our businesses and help our patients, but our responsibility as Doctors of Chiropractic is to verify that we are doing the right things in the right ways. When we don’t, it doesn’t just cost us, but it is often our patients who suffer when fines and penalties of this magnitude result in closed doors.
As a chiropractor, I want my team to focus on patient care. As a business owner, I have a responsibility to make sure that what we do is compliant. That is why I contracted with a compliance team to ensure that what we are being as compliant as possible. I don’t have to know all of the answers, because I work with experts who do. With all the rules and regulations around healthcare today, it can be difficult to see just where your risk may lie. I strongly recommend that you receive a free Gap Analysis from ChiroArmor. At the very least, it will let you know the areas of risk in your practice, so you can begin taking steps to minimize them.
Click here to schedule your FREE Gap Analysis with ChiroArmor today.
Why is the Discount Challenge prize amount $11,181? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $11,181 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.