medical compliance specialists


Who do you trust to help you in compliance?

Based on information gathered, the OIG in 2001 determined that 67% of all claims filed for Medicare had errors or were fraudulent. It is for these reasons that OIG has targeted the Chiropractic field. Many of the billings had incorrect codes or modifiers. Bills were also submitted for non-covered treatments.

The lack of proper documentation of treatment is a major concern the OIG has identified. The documentation of a patient's treatment should be completed within 24 hours after the treatment.

OIG further reports that for every $1.00 they spend on an investigation or audit, they can recoup $17.00 in addition to penalties. The audit repayment averages to the government were as such for a practice with:

  • 70 patients per week: $40,000
  • 200 patients per week: $160,000
  • 350 patients per week: $800,000

And then there is the possibility of PRISON if you are found to be fraudulent.

The OIG takes into consideration in many cases during their investigations if a practice has taken steps and made a true effort in becoming Medicare Compliant.

A Compliance Program should be designed to meet the needs of each individual clinical site based on the OIG guidelines. The OIG has advised that there are three areas that must be specifically addressed in a Compliance Program: Development, Implementation, and Monitoring.

Many physicians and chiropractors feel they did not spend time studying in school to be tethered to a desk and have to deal or feel they are too busy to deal with a Compliance Program. Many would rather spend time o patient care.

Unfortunately, doctors stand to lose a great deal if ever audited and violations are found. Some of the things that could be lost are: Money or financial gains, loss of practice, privileges afforded by the Government and Insurance Companies, respect, FREEDOM if sent to prison.

Some may know compliance, but they know little about the chiropractic office. Some know chiropractic procedures, but really don't know about compliance. Dr. Diane Barton is a Certified Insurance Consultant and a Certified Medical Compliance Specialist. James Minx is a Certified Medical Specialist and insurance consultant.

Call us at (708) 922-3911 to schedule your OIG Compliance Audit before the Feds do!

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