An impressive article by John Mac Ghlionn caught my attention. Allow me to quote a few passages from it:
The U.S. House of Representatives and the U.S. Senate recently reintroduced legislation to increase access to Medicare-covered services provided by chiropractors. Last year, the US chiropractic market size was worth $13.13 Billion. By the end of the decade, it will be worth over $18 billion. Each year, a whopping 35 million Americans seek chiropractic care.
But why? It’s a questionable science full of questionable characters.
Last year, a Georgia woman was left paralyzed and unable to speak after receiving a neck adjustment from a chiropractor. She’s not the first person to have had her life utterly ruined by a chiropractor, and chances are she won’t be the last. Many patients who visit chiropractors suffer severe side effects; some lose their lives…
As Dr. Steven Novella has noted, what used to be fraud is now known as holistic medicine. Dr. Edzard Ernst, a retired British-German physician and researcher, has expertly demonstrated the many ways in which chiropractic treatments are rooted not in science, but in mystical concepts…
Spinal adjustments, also known as “subluxations,” are also common. A dangerous practice that has been heavily criticized, spinal manipulations are associated with a number of adverse effects, including the risk of stroke. As Dr. Ernst has noted, the cost-effectiveness of this particular treatment “has not been demonstrated beyond reasonable doubt.”
Not content with spinal and neck manipulations, some chiropractors offer to treat other conditions — like diabetes, for example. They are not trained to treat diabetes. Other chiropractors appear to take joy in torturing infants. In August of 2018, a chiropractor made headlines for all the wrong reasons when a video emerged showing him hanging a two-week-old newborn upside down by the ankles…
Finally, as I alluded to earlier, the chiropractic community is full of fraudsters. In 2019, in the US, 15 chiropractors were charged in an insurance fraud and illegal kickback operation. More recently, in February of this year, a New York federal judge sentenced Patrick Khaziran to 30 months in prison after he pleaded guilty to being part of a widespread scheme that defrauded the NBA out of at least $5 million. In recent times, the chiropractic community has come under scrutiny for abusive care and illegal billing practices. When it comes to instances of healthcare fraud, chiropractic medicine is unrivaled.
None of this should come as a surprise. After all, the entire chiropractic community was constructed on a foundation of lies. As the aforementioned Dr. Ernst told me, we should be skeptical of what chiropractors are offering, largely because the whole practice was founded “by a deluded charlatan, who insisted that all human diseases are due to subluxations of the spine. Today, we know that chiropractic subluxations are mere figments of Palmer’s imagination. Yet, the chiropractic profession is unable to separate itself from the myth. It is easy to see why: without it, they would at best become poorly trained physiotherapists without any raison d’etre.”
… Dr. William T. Jarvis famously referred to chiropractic as “the most significant nonscientific health-care delivery system in the United States.” Comparing the chiropractic community to a cult, Dr. Jarvis wondered, somewhat incredulously, why chiropractors are licensed to practice in all 50 US states. The entire profession, he warned, “should be viewed as a societal problem, not simply as a competitor of regular health-care.”
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In my view, this is an impressive article, not least because it is refreshingly devoid of the phenomenon known as ‘false balance, e.g. a chiropractor being invited to add his self-interested views at the end of the paper claiming, for instance, “we have years of experience and cause far less harm than real doctors”.
41 Responses to The Dark Side of Chiropractic Care
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Is there not a dark side?
oh my, the chiropractic profession has a few bad characters. Shocking.
“the chiropractic profession has a few bad characters”
The chiropractic profession has a few bad charlatans; far too few.
Well, yes we have those too. Did anyone say otherwise?
LOL! Another succinct, yet powerful, demonstration of stupid-squared. Well done!
Ever considered parsing the complete sentence before replying to it.
Not just a few bad apples. Most of chiropractic profession is rotten to the core.
“Claims Expert: Fraud in Chiropractic Billing Has ‘Become an Issue’
A federal audit found that more than 80 percent of chiropractic care provided to Medicare patients that year was unnecessary. ”
https://www.dmagazine.com/healthcare-business/2023/02/claims-expert-fraud-in-chiropractic-billing-has-become-an-issue/
To be accurate they found in most of those cases that the care did not comply with Medicare requirements.
Much of that is due to documentation issues. The label of “unnecessary” is vague.
DC says: “Much of that is due to documentation issues. ”
@DC
From the article I referred to earlier.
“General audit found that about $358.8 million, 82 percent, of the $438.1 million that Medicare paid for chiropractic services was unnecessary. ”
Are you implying that chiros are so very incompetent that they can’t submit proper paperwork and that caused 358 million dollars in wasted tax payer funds?
I think there is an much simpler explanation. Chiros like this fellow are plenty in your profession.
“Keokuk chiropractor accused of Medicare fraud exceeding $1 million
Chiropractor also faced charges of fraud and unethical conduct in 2015”
https://iowacapitaldispatch.com/2023/07/05/keokuk-chiropractor-accused-of-medicare-fraud-exceeding-1-million/
Did you know that if the patients ID isn’t on every single piece of paperwork that they can deny the claim and call it “unnecessary”?
One needs to read the full report.
Did you know that omitting the patients ID on every single piece of paperwork smells like deliberate fraud?
@DC
Did you know that there are instances of outright fraud by chiros highlighted in the article I referred to earlier? Here it is again for your convenience: https://www.dmagazine.com/healthcare-business/2023/02/claims-expert-fraud-in-chiropractic-billing-has-become-an-issue/
One needs to read the news: https://www.justice.gov/usao-cdca/pr/second-highest-chiropractic-medicare-biller-california-biller-pleads-guilty-health-care
https://www.justice.gov/usao-cdca/pr/former-chiropractor-found-guilty-health-care-fraud-charges-she-schemed-defraud-health
Bolding mine.
Apparently the dark side of chiropractic involves high crimes, not paperwork errors.
Who said it was omitted on every piece of paper? It only has to be omitted on one.
Talker. I never said there isn’t fraud.
I did comment on payments being classified as unnecessary and gave an example which would most likely not be considered fraud.
@DC
My original comment and article I linked to was on fraud. Instead, you chose to comment on something that might not be fraud. This highlights the diversionary tactics you typically use to lead the conversation away from the dark side of chiropractic.
From the article
“An Office of Inspector General audit found that about $358.8 million, 82 percent, of the $438.1 million that Medicare paid for chiropractic services was unnecessary.”
Hence my comment.
You want to focus on fraud, go for it.
LOL DC. I don’t need your permission. If you read my previous comments on this post and on previous posts, I have been focusing on chiropractic fraud. So is EE: https://edzardernst.com/2023/07/chiropractor-accused-of-medicare-fraud-exceeding-1-million/
you say you are focusing on fraud, yet this is what you wrote.
“A federal audit found that more than 80 percent of chiropractic care provided to Medicare patients that year was unnecessary. ”
So I shed some light on that percentage. It is not my problem if you don’t like clarification.
No matter how you spin it, providing unnecessary medical care to patients and billing Medicare for said unnecessary care IS fraud.
By the way, would you like to shed some light on this racket of chiros committing insurance fraud?
https://www.cbsnews.com/minnesota/news/multi-million-dollar-insurance-fraud/
Spin “Doctors” indeed…reminds me of a great book as well! As always is the case, they put a whole new spin on spin.
There’s pure gold in these exchanges. LOL
How I wish every chiropractor could view this educational and informative site! Perhaps DC could share with his buddies.
Next!
chiro‑troll wrote “Much of that is due to documentation issues. The label of ‘unnecessary’ is vague.”
The meaning of “unnecessary” is crystal clear. It is the antonym of “necessary”. It is that which is NOT NECESSARY; and that which IS NECESSARY is documented by Medicare. By definition, the former [“unnecessary”] becomes increasingly vague as the latter [“necessary”] is made increasingly clear.
QUOTE
When all sets in the universe, i.e. all sets under consideration, are considered to be members of a given set U, the absolute complement of A is the set of elements in U that are not in A.
If A is a set, then the absolute complement of A (or simply the complement of A) is the set of elements not in A (within a larger set that is implicitly defined).
https://en.m.wikipedia.org/wiki/Complement_(set_theory)
END of QUOTE
It sad to need to state the bleedin’ obvious to a bunch of quacks who are so grossly incompetent that they can’t even put the patient ID on every sheet/page of their paperwork. Pathetic.
Talker.
Medical unnecessary is when it is not “reasonable and necessary for the diagnosis or treatment of illness or injury.”
“The difference between “fraud” and “abuse” depends on specific facts, circumstances, intent, and knowledge.”
“Abuse describes practices that may directly or indirectly result in unnecessary costs to the Medicare Program. Abuse includes any practice that does not provide patients with medically necessary services or meet professionally recognized standards of care.”
“Medicare fraud typically includes: Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a Federal health care payment for which no entitlement would otherwise exist.”
https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Fraud-Abuse-MLN4649244.pdf
This is the criteria for chiropractors to demonstrate medical necessity. If, upon an audit, not all of the requirements are found, the care is classified as unnecessary.
https://www.cgsmedicare.com/partb/mr/pdf/chiropractic.pdf
Fraud may or may not be applicable, depending on several factors.
DC,
86% did not document medical necessity: https://edzardernst.com/2023/07/the-dark-side-of-chiropractic-care/#comment-146862 and the numbers indicate a systemic problem within the chiro community.
This begs the question, why would so many chiros not document the most basic thing necessary to file a Medicare claim? Is it just gross incompetence? Or are they hoping that if they don’t document medical necessity there is no way for Medicare to determine whether the treatment is medically necessary or not and they can easily get away with performing treatments that Medicare would not approve?
Here is case where a chiropractic clinic raked in millions by performing unnecessary treatments among other things and got caught. Below are some excerpts from the article: https://www.aarp.org/money/scams-fraud/info-2023/dolson-avenue-medical.html.
I haven’t seen a breakdown of the most common Medicare documentation errors/reasons.
I know a few folks that do elective audits, I’ll ask.
Talker,
A couple of common reasons for failing a Medicare audit (determined medically unnecessary)
Didn’t record how each condition changed from the prior visit.
Didn’t record the effectiveness of the treatment.
DC,
If we take the information you obtained at its face value, effectiveness of the treatment and change in condition between visits are critical pieces of information that should be documented.
Therefore, my question: why would SO MANY chiros fail to document basic things necessary to file a Medicare claim? remains unanswered.
If I had to guess, omitting that info allows chiros to continue treating patients even after it is not necessary to do so. It would be considered fraud if they outright lie and say the patient is not getting better when they are and continue treating them. Therefore, lying by omission is probably a safe bet for a chiro, legally.
I thought such widespread incompetence of US chiropractors was identified and addressed in 2015 — eight years ago.
Talker,
There may be several reasons why a chiropractor fails to do these requirements.
Regardless, my point is that Medicare would classified it as medically unnecessary but not necessarily consider it fraud.
DC,
In case you haven’t noticed, the conversation moved on from Medicare classifications to systemic incompetence of chiros when filing Medicare claims.
Talker, when you admit that this claim is wrong, then one can move on
“…providing unnecessary medical care to patients and billing Medicare for said unnecessary care IS fraud.”
DC,
I was talking about instances of outright fraud, see the link in that and subsequent posts that highlight outright fraud. Not my problem if you did not understand. You are the one who kept diverting the conversation to what Medicare classifies as fraud when I made it clear in earlier posts that I was talking about fraud and linked to many examples of fraud.
Here is another example: https://www.dol.gov/newsroom/releases/ebsa/ebsa20200825-0
Bolding mine.
I questioned the accuracy of your response and your reference as it pertains to fraud.
Talker: “Not just a few bad apples. Most of chiropractic profession is rotten to the core.
“Claims Expert: Fraud in Chiropractic Billing Has ‘Become an Issue’
A federal audit found that more than 80 percent of chiropractic care provided to Medicare patients that year was unnecessary.”
And sure, you can post examples of actual fraud by chiropractors, fraud can be found in any health profession.
“fraud can be found in any health profession”
sure
but other professions can show that collectively they do some good.
I bring you the latest in chiro malfeasance, from a never-ending list of chiro crimes indexed by Google.
https://www.local10.com/news/local/2023/04/20/miami-chiropractor-surgeon-sentenced-in-31-million-medicare-fraud-scheme/
https://www.kansas.com/news/local/crime/article277424558.html
Here’s the previous ‘discussion’ thread on the above article Claims Expert: Fraud in Chiropractic Billing Has ‘Become an Issue’:
https://edzardernst.com/2023/02/a-young-womans-visit-to-a-chiropractor-left-her-unable-to-walk/#comment-144553
Yep.
“However, the chiropractors did not document the medical necessity of 559 services (86 percent) as required by Medicare; an additional 56 services (9 percent) were either not documented or insufficiently documented.”
Do you even know the requirements for a chiropractor to document medical necessity? I doubt it.
LOL!
I can’t begin to imagine how difficult it is for any species of quack to document as ‘a medical necessity’ that which is not, by definition, medicine; let alone a necessity.
Furthermore, I can’t begin to imagine the staggering depth of ineptitude that is required in order to submit documentation that does not have the patient ID on every sheet/page.
The contents of your plethora of pseudo-discussions on this website, spanning the last seven years, shed much light on the types and depths of incompetency, which in the realm of pseudo-medicine not only flourishes, it is also flaunted.
In all the branches of applied science that I have been involved with, such a grossly incompetent person wouldn’t be left unsupervised with a pencil sharpener.
Many thanks for asking me yet another of your asinine questions.
So apparently you don’t know.
Apparently? Do you expect me to copy and paste the numerous relevant paragraphs from the Medicare stipulations, just to demonstrate that I have read them. Now, after your pathetic attempt at distraction…
You have informed us of the following :
So, you don’t discuss subluxations with your ‘patients’, but you do diagnose subluxations and treat subluxations for the purpose of receiving about $20 per pop from Medicare.
That smells of fraud. Obviously not medical fraud because chiropractic isn’t a branch of medicine. But as you have clearly stated:
Well done.
If you were familiar with Medicare billing, you would know Medicare describes that we are billing for the adjustment of “Segmental and somatic dysfunction” example M99.01.
And who authorized to set up the CPT codes? The AMA.
Try to stay informed.
So, your comments show that you’ve been telling porkies.
https://en.m.wikipedia.org/wiki/Lie
Oh, wait, perhaps it’s your par for the course deployment of lying by omission? Let’s see…
This particular type of lying is enacted via equivocation combined with misdirection via wilful obscurantism.
If you struggle with that list, I can copy it here with the matching terms highlighted.
So just ask my wife how she feels about the dark side of chiropractic!
Better yet, ask me what I think of how the Canadian Chiropractic Protection Agency (CCPA) that oversees the bad actors, effectively deal with cleaning up their “dark side”.
The agency that provides many Chiropractors with their insurance coverage insurance and “dishes out discipline” from within. When one of their own admits to lying under oath, forges patient’s signature’s and alters client’s medical records, they seemingly go limp when handling their own affairs.
Our own story is a prime example of the Fox guarding the Henhouse.
Given what my wife has endured, to this day this still doesn’t sit well with me. Somehow a three-month suspension from practicing Chiropractic and the Chiropractor being dropped from their insurance coverage, just seems to miss the mark in my humble opinion.
Were a real Doctor to have caused such catastrophic damage, comparable to what happened to my wife Sandra Nette, and then also committed perjury along with altering her medical records and forging her consent signiture, , I suspect the consequences and disciplinary measures sanctioned by our Colledge of Physicians and Surgeons would have been swift and severe.
Dark side indeed.