Dr. R. A. Foxworth, FICC, MCS-P
As a ChiroHealthUSA practice, you already know that your provider status allows you to offer legal discounts to your patients and protects you from the risks associated with dual fee schedules, illegal time-of-service discounts, inducement, anti-kickback accusations, and false claims act violations.
But you may not know that ChiroHealthUSA is a key tool in your belt when it comes to fishing expedition-style records requests and audits. What? You say you’ve never been audited and can’t imagine that you ever will be? We wish we could tell you that you’re right, but the statistics just don’t bear this out. Today’s Office of Inspector General (OIG) is aggressive and motivated. It’s no longer a question of if you’ll be audited, but when.
The OIG puts chiropractic documentation error rates at 90-94%, higher than any other kind of provider. Like it or not, this puts a target on your back, and it’s why the OIG devotes continues to focus resources on chiropractic practice scrutiny. They know from experience that they’ll find patterns of up-coding, down-coding, and miscoding, inadequate proof of medical necessity, and missing or incomplete information. It doesn’t matter whether you make mistakes out of ignorance or malice. The recoupments can be brutal either way.
One thing is certain. Whistling in the dark, which is what we do when we are in denial about audit risk, is a set-up for a big fall. You may never have been audited before. You may think you don’t know any colleagues who’ve ever been audited (chances are, you do—doctors don’t tend to brag about getting slapping with fines, penalties, and recoupments). But the fact is, no one ever gets audited—until the day that they do.
That day came in August of this year for a Michigan chiropractor, one of a list of doctors the OIG has targeted for improper Medicare reimbursements. His outcome: he has to pay over $339,000! Gut-punching Medicare recoupments like this, coupled with unheard-of HIPAA fines and penalties for non-compliance, make this, as one expert says, “the scariest regulatory environment in history.”
ChiroHealthUSA stands ready to help. We give you access to some of the best and brightest minds in the business on areas such as documentation, coding, and compliance. We work with Medicare specialists who are leaders in the profession and we can get you the best and most complete answers to almost any question you can come up with.
In addition, we stay up-to-date and even ahead of the curve on issues coming down from the OIG, HHS, CMS, private insurers, and regional MACs. Our weekly webinars are a wonderful source of timely and relevant information about the latest issues facing our profession, as well ideas for a more profitable practice in 2017. December’s webinar, with Ty Talcott, takes an unflinching look at the new round of HIPAA and OIG audits coming up—and what you can do to prepare your practice and reduce your risk.
▶︎ 
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.