by Ray Foxworth, D.C., FICC •
President & Founder, ChiroHealthUSA •
In recent years, data analytics has become a powerful tool for the U.S. Department of Justice (DOJ) in cracking down on healthcare fraud. Like other healthcare professionals, chiropractors must proactively protect their practices against fraud allegations and compliance issues. Here’s how you can safeguard your chiropractic business and reduce legal risks:
Monitor Billing Practices
The DOJ uses data analytics to identify fraudulent billing by analyzing patterns and outliers. It’s essential for chiropractors to regularly review their billing practices and ensure they align with legal standards. Implementing a robust system to track and analyze billing data can help spot discrepancies early, allowing you to correct mistakes before they become problematic.
Implement a Strong Compliance Program
A well-structured compliance program is your first line of defense. The DOJ places significant emphasis on the effectiveness of corporate compliance programs when investigating businesses. Chiropractors should have clear protocols for handling patient data, billing, and services rendered. Regular training and updates for staff on compliance can help you avoid unintentional errors.
Stay Ahead of Whistleblower Claims
Whistleblowers often rely on data analytics to expose fraudulent activity, such as billing for services not performed or undocumented. By staying vigilant and addressing any irregularities within your practice, you can proactively mitigate the risk of being targeted in a whistleblower case. Internal audits and root cause analyses can help identify and rectify potential issues early on, keeping you one step ahead.
Know the Legal Landscape
The DOJ continues prioritizing healthcare fraud under laws like the False Claims Act (FCA). With nearly 70% of FCA settlements in 2023 coming from healthcare, chiropractors must stay informed about legal developments in the industry. New enforcement priorities, such as telemedicine, cybersecurity, and third-party billing accountability, could impact your practice. (McDermott Will and Emory, 2024)
Seek Expert Legal Advice
Given the complexities of the legal system, it’s wise to consult with legal professionals specializing in healthcare compliance. Expert guidance can give you the reassurance and confidence to prevent costly legal battles, whether reviewing your billing practices or understanding new FCA developments.
Data is a double-edged sword in today’s environment—it can expose flaws or help protect your practice. By staying proactive, monitoring compliance, and seeking expert advice, chiropractors can avoid the pitfalls of fraud investigations and maintain a legal, thriving practice. (Barnes & Rose, 2024)
By following these steps, you’ll be better positioned to shield your chiropractic practice from potential legal challenges and ensure compliance with federal regulations. If you are unsure where to start or concerned about gaps in your current compliance program, schedule your free Gap Analysis with ChiroArmor here. This will give you a sense of security and control over your practice’s future.
▶︎ 
Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 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.