HEALTH FRAUD - How Is The Chiropractic Profession Involved?

By Editorial Staff

Approximately $20-$30 BILLION dollars are lost each year to health fraud. This problem has worked its way to the top of the priority list for the Federal Trade Commission, the Food and Drug Administration, state attorneys general, The U.S.

Department of Health and Human Services' Office of Inspector General, and the U.S. Postal Service.

Most health fraud is committed by the "patient" or other parties. But, two percent is committed by health care providers. In 1984, the Office of the Inspector General published a breakdown of health care fraud by provider:

M.D.'s - 36%
D.C.'s - 21%
D.O.'s - 13%
D.P.M.'s, Nurses, Social Workers, Psychologists - 12%
D.D.S.'s - 7%
Ph.D.'s - 5%
Naturopaths and Herbalists - 4%
O.D.'s - 1%

Ann Boulware,R.N. of Blue Cross and Blue Shield of Kansas City's Investigative Unit, explains that health fraud can take two forms:

"Classic Fraud" - which involves outright deceit

"Non-Classic Fraud" - which involves subtle procedures that coincidentally benefit the physician.

Classic Fraud includes billing for services not rendered, deceptive billing and fee splitting with patients.

Non-Classic Fraud is much more rampant. This type of health fraud usually involves overutilization and/or use of unnecessary treatment. This can include everything from unnecessary exams to upgrading treatment.

Most authorities agree that health care fraud is on the increase. In her presentation at the National Council Against Health Fraud's annual conference, Ms. Boulware contends that much of the increase in health fraud within the chiropractic profession has occurred due to the unethical teachings of a few practice management consultants.

While some within the chiropractic profession would argue with the focus on chiropractic health fraud that Ms. Boulware and the investigative unit have developed as it relates to some practice management consultants, the impact is undeniable. The techniques of overbilling, overutilizing and overprescribing have taken their toll, regardless of who taught them to whom.

These unethical practices, while only practiced by a relative few, have created their own ugly reputation. A reputation that will continue to taint the chiropractic profession for many years to come.

The only question remaining is: Can the chiropractic profession reverse the process and redeem its reputation?