Where the practice of medicine is concerned, the field of chiropractic doesn’t have a strong reputation, which is attested by a Wikipedia article detailing a long list of scientific controversies and criticism of the field.

Never-the-less, despite ongoing questions of many of its practices and their effectiveness as medical treatments, a limited number of chiropractic services are covered by Medicare.

Which brings us to a whole different problem caused by a significant number of chiropractic practitioners, who appear to have unlocked the secret to extracting hundreds of millions of dollars annually from Medicare by providing chiropractic services to senior citizens that the program does not cover. Lois Norder of the Atlanta Journal-Constitution explains how they have been getting away with it:

Make off with millions by going small and flying under the government radar. That seems to be the takeaway in a new report by a government watchdog.

Every year, Medicare is shelling out hundreds of millions of dollars for massages, acupuncture and other ineligible or medically unnecessary services that are billed by chiropractors, says the report, by the inspector general of the federal health department.

Medicare patients are out millions, too, for coinsurance payments to chiropractors for medically unnecessary services, according to the report.

Yet despite years of warnings about the problem, the agency responsible for overseeing Medicare – the Centers for Medicare and Medicaid Services — hasn’t made it a priority to identify and stop the waste, fraud and abuse, says the report.

One reason: Payments for individual chiropractic services are small, ranging from $29 to $54 dollars, the report says. But, the OIG notes, Medicare is paying more than $450 million a year for the services.

That strategy means that unscrupulous chiropractors are bombarding Medicare’s billing services with somewhere from 8.3 million to 15.5 million of these small dollar value bills per year.

There are really two problems at work here. First, the Centers for Medicare and Medicaid Services doesn’t appear to have either the ability or the willingness to impose greater discipline on its reimbursement practices, where the high volume of small bills being submitted by chiropractors are being processed and paid despite being ineligible for reimbursement. Even at an annual total of $450 million, the waste represented just 0.08%, or less than one-tenth of one percent, of the Medicare program’s total amount of spending of over $597 billion in 2017. For the estimated 6,000 bureaucrats who work for the Centers for Medicare and Medicaid Services, that’s the equivalent of saving $75,000 out of the $99,500,000 of spending that each would be responsible for overseeing each year, assuming they equally divided that task among themselves.

The second problem is that the Centers for Medicare and Medicaid Services would appear to be dealing with some really unscrupulous chiropractors among its worst inappropriate billing cases, which is made clear in the following anecdote from Norder’s article:

The agency also tried educating chiropractors on Medicare billing requirements. But, the report says, chiropractors in at least one jurisdiction “were resistant to education and not willing to change their billing patterns.”

And thus, Medicare is being taken to the cleaners by unscrupulous chiropractors to the tune of $450 million a year in chiropractic services that it doesn’t cover, for cases that the U.S. Department of Justice’s Medicare Fraud Strike Force Teams apparently deem too small to pursue and prosecute.

As for solving the problem, perhaps greater federalism would be in order.

Since chiropractors are directly regulated and licensed by state governments, wouldn’t it make more sense to enlist state regulators to ensure that chiropractors are in compliance with both state and federal billing practices? Since they would have the power to pull the license of any chiropractor who might be “resistant to education” where establishing effective and honest billing practices are concerned, the Centers for Medicare and Medicaid Services might get a lot more bang for its fraud-fighting buck if it were to follow that approach instead of continuing whatever it isn’t doing to stop the waste today.

For added effectiveness in eliminating waste beyond the $450 million what has been documented by its Inspector General annually for chiropractic services, it may also be desirable to transfer the administration of Medicare’s entire billing reimbursement program to the states. Remember, what is wasted just on chiropractic services that aren’t approved to be covered by Medicare is just a tiny fraction of the waste that is being generated across all of the medical services for which Medicare is paying the bills.

Or for that matter, we should perhaps consider transferring the administration of the entire Medicare program to the states, since it seems to have grown well beyond Washington D.C.’s ability to manage well enough to avoid wasting hundreds of millions, if not billions, in billing fraud each year.