Orlando Harmon
Chiropractors have been known to commit insurance fraud by billing Medicare for services not provided to patients. This includes falsifying patient records and signatures to make it appear as though treatments were carried out. If you believe you have been overcharged or have discovered insurance fraud by a chiropractor, you can report the incident. Each state has its own medical board or chiropractic board that oversees medical professionals, and the Federation of Chiropractic Licensing Boards can provide information on how to pursue a complaint. Additionally, the False Claims Act and other federal and state laws help enforce requirements and eliminate fraud in Medicare and other public healthcare programs.
| Characteristics | Values |
|---|---|
| Evidence of fraud | Evidence of being overcharged, mistreated, or insurance fraud |
| Information to provide | As much information as possible, including dates and services |
| Who to report to | The state medical board, chiropractic board, or the Federation of Chiropractic Licensing Boards |
| Contact | Call 1-800-MEDICARE (1-800-633-4227) or Report Medicare Fraud online |
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What You'll Learn
Gather evidence and information
If you believe you have been mistreated, overcharged, or have discovered insurance fraud by a chiropractor, you can report the incident. When reporting fraudulent actions, you should be prepared to offer as much information as possible. Here are some steps to help you gather evidence and information:
- Review your medical records: Collect and organize all your medical records related to the treatment you received from the chiropractor. This includes initial consultations, treatment plans, progress reports, and any other relevant documents. Look for any discrepancies or falsified information in these records. For example, chiropractors must maintain specific documentation, specifying the precise level of subluxation and the patient's treatment plan.
- Compare with Medicare statements: If you are a Medicare beneficiary, compare the dates and services on your calendar or personal records with the Medicare statements you receive. Ensure that you received each service listed and that all the details are accurate. Medicare only covers a chiropractor's ""active/corrective treatment" of spinal subluxation, which must provide a reasonable expectation of recovery or improvement of function.
- Check for unnecessary procedures: Medicare reimbursements for chiropractic treatments must be medically necessary and supported by appropriate documentation. Review your records to identify any procedures or treatments that may not have been necessary or were performed solely for financial gain.
- Look for red flags: Familiarize yourself with common signs of insurance fraud. This includes billing for services not provided, falsifying patient records, and offering unnecessary treatments. Be vigilant and trust your instincts. If something doesn't seem right, make a note of it and investigate further.
- Gather supporting documentation: Collect any additional documentation that can support your claim. This may include correspondence with the chiropractor, emails, text messages, or other communications. Any evidence that contradicts their reported services or demonstrates their intent to commit fraud will be valuable.
- Contact your insurance company: Reach out to your insurance company and request a copy of all claims submitted by the chiropractor. Review these claims for any discrepancies or inflated charges. Look for services that were billed but not provided, or services that were incorrectly coded to maximize reimbursement.
Remember, the more evidence and information you can gather, the stronger your case will be when filing a complaint or report. Take your time to thoroughly review all available documentation and seek assistance if needed.
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Contact a relevant lawyer
If you are facing charges of insurance fraud, you should contact a lawyer as soon as possible. Insurance fraud is a serious criminal offence, and a conviction can carry a felony charge, as well as fines and a prison sentence of up to 30 years.
When choosing a lawyer, it is important to find someone with experience in handling insurance fraud cases. A good lawyer will be able to explain the charges, the facts underlying them, and what your legal defence options are. They will also be able to advise you on the best tactics to win at trial, such as demonstrating how the prosecution has failed to prove its case beyond a reasonable doubt.
There are several law firms with experienced fraud defence lawyers, such as Spolin Law P.C. in Los Angeles, and Smith & Eulo Law Firm in Florida, who offer free initial consultations. You can use Google and Yelp to locate lawyers near you with experience in insurance fraud cases.
If you believe that you have been the victim of insurance fraud, you should consult an insurance bad faith lawyer. They will be able to review your options for making a claim against the insurance company or individual that has committed fraud against you.
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Submit a complaint to the state medical board
If you believe a chiropractor has committed insurance fraud, you can submit a complaint to your state medical board. The process may vary depending on your location, but here is a general guide:
Firstly, it is important to understand the jurisdiction of your state medical board. For example, the Texas Medical Board does not have the authority to investigate dentists, hospitals, or insurance companies. Therefore, before submitting your complaint, ensure that your claim falls within the board's jurisdiction.
Once you have confirmed their jurisdiction, you should gather any relevant evidence to support your complaint. This may include medical records, billing statements, or any other documentation that can help substantiate your claim. Keep in mind that chiropractic treatments must be medically necessary and supported by appropriate documentation to be eligible for reimbursement from Medicare or insurance companies.
Most state medical boards accept written complaints, which can be submitted by mail, fax, or online. In California, for instance, the Medical Board of California (MBC) requires that complaints be filed in writing, except in special circumstances. The MBC investigates complaints involving doctors of medicine, doctors of osteopathic medicine, and doctors of podiatric medicine. Their investigations include reviewing allegations of quality of care, such as misdiagnosis, negligent care, or surgical complications.
When submitting your written complaint, be sure to include as much detail as possible, including the name of the chiropractor, the dates of treatment, and a detailed description of the alleged fraud. You may also need to provide your contact information so that the board can follow up with you regarding your complaint. Please note that the board may share your information with the business you are complaining about or with other government agencies during the investigation process.
After submitting your complaint, the state medical board will review and evaluate it. If the board has the authority to investigate your complaint, they will initiate an investigation into the allegations. Depending on the nature of your complaint, they may take disciplinary action or refer the case to the appropriate licensing board or bureau for further action.
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Report to the Federation of Chiropractic Licensing Boards
If you believe a chiropractor has committed insurance fraud, you can report them to the Federation of Chiropractic Licensing Boards. The Federation of Chiropractic Licensing Boards is a repository of all chiropractic licensing boards' disciplinary actions.
Before submitting a report, it is important to gather any evidence of the fraud. Evidence may include documentation of treatments and services that were billed but not provided, falsified patient records and signatures, or any other information that may support your claim.
Once you have gathered your evidence, you can submit a written complaint to the Federation of Chiropractic Licensing Boards. In your complaint, be sure to include as much detail as possible, including the name of the chiropractor, the specific actions or behaviours that you believe constitute insurance fraud, and any relevant dates or locations. You should also include copies of any supporting documentation or evidence that you have gathered.
After receiving your complaint, the Federation of Chiropractic Licensing Boards will review it and determine whether they have jurisdiction to take action. If they proceed with your case, they may conduct a further investigation. If the complaint is substantiated, formal disciplinary action may be taken against the chiropractor's license, ranging from a public reprimand to probation or even license revocation.
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Call the Medicare Fraud hotline
If you suspect a chiropractor of committing insurance fraud, you can call the Medicare Fraud hotline by dialing 1-800-MEDICARE (1-800-633-4227). This hotline is dedicated to receiving reports of potential Medicare fraud, including fraud committed by chiropractors. When you call the hotline, you will be able to speak to a representative who will take your report and may ask you for detailed information about the suspected fraud. It is important to be prepared with as much information as possible, including any documentation or evidence that supports your claim.
Before making the call, it is advisable to familiarize yourself with the signs of Medicare fraud. For instance, chiropractors may bill Medicare for services not provided, falsify patient records and signatures, or provide medically unnecessary procedures. Medicare only covers a chiropractor's ""active/corrective treatment" of spinal subluxation, and services rendered must demonstrate a reasonable expectation of recovery or improvement. Chiropractors are required to maintain specific documentation, including the precise level of subluxation and the patient's treatment plan.
When you call the Medicare Fraud hotline, you can expect to be asked for details about the suspected fraud. This may include information such as the name and location of the chiropractor being reported, the dates of service in question, and a description of the fraudulent activity. It is helpful to have any supporting documentation or evidence readily available to provide a comprehensive report. If you are unsure about the specifics of the fraud, you can still call the hotline to express your concerns, and they will guide you through the next steps.
Calling the Medicare Fraud hotline is a crucial step in addressing suspected insurance fraud by chiropractors. It allows the appropriate authorities to investigate the matter and take corrective action. By reporting fraud, you are helping to protect the integrity of the Medicare system and ensuring that funds are used appropriately to provide necessary care to those who need it. Remember, it is your right and responsibility to speak up if you suspect any fraudulent activity within the Medicare system.
In addition to calling the Medicare Fraud hotline, there are other resources available to report suspected insurance fraud by chiropractors. You can also report Medicare fraud online or contact organizations like Constantine Cannon, which assists whistleblowers in exposing healthcare fraud. It is important to remember that Medicare will never call you out of the blue to ask for personal information. Always be cautious about protecting your Medicare card, number, and personal information.
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Frequently asked questions
Insurance fraud by a chiropractor involves the chiropractor engaging in deceptive practices to obtain financial gain from insurance companies. This can include billing for services not provided, exaggerating treatment durations, or falsifying medical records to indicate unnecessary or nonexistent procedures.
Signs of insurance fraud by a chiropractor can include being overcharged, being pressured to accept unnecessary treatments, or noticing discrepancies between the services received and those listed on insurance statements. It's important to review your insurance claims regularly and protect your personal information.
If you suspect insurance fraud by a chiropractor, you should gather as much information as possible, including documentation and evidence of the fraudulent activities. You can then file a complaint with your state's medical board or chiropractic board, as each state has its own regulatory body overseeing medical professionals. Additionally, you can contact legal organizations specializing in whistleblower cases or report Medicare fraud directly to Medicare or law enforcement agencies.
When reporting a chiropractor for insurance fraud, it is essential to provide as much detailed information as possible. This includes dates and descriptions of the fraudulent activities, copies of relevant documents or communications, and any evidence that supports your claim. It is also helpful to provide your own contact information and consent to be contacted for further investigation if needed.
You can contact legal organizations, such as Constantine Cannon, that specialize in whistleblower cases and have experience in chiropractic fraud. They can guide you through the process and protect your rights. Additionally, you can reach out to your local State Health Insurance Assistance Program (SHIP) or law enforcement agencies, such as the Federal Bureau of Investigation (FBI), which handles undercover fraud investigations. These resources can provide you with support and assistance in reporting chiropractic insurance fraud.
