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Back Pain Belt becomes pain for provider

A chiropractor in Indiana will be spending up to 12 ½ years in prison for defrauding Medicare, Medicaid and private insurance by selling a back-pain belt of his own design and billing it as a custom fabricated back brace. The chiropractor made three critical errors. First, he could not justify his belt design as a custom fabricated back brace worth more than $1,300. The belt was fabricated only in standard sizes, and the government's experts testified that the belt was similar to a weightlifting belt that should have been billed at less than $50. Second, he targeted the elderly and prescribed the belts based upon very cursory physical examinations with little or no health history. Third, he gave patients free food, a free neck or back pillow, and a free massage from a massage therapist. While the Court agreed that a physician could provide incentives of nominal value (up to $10 per item and $50 in total during the year), the combined value of the chiropractor's gifts exceeded $50 per patient. The chiropractor received more than $1,500,000 selling the back-pain belts over a 2 ½ year period.

There are two lessons to be learned from this case. The first lesson is the need to validate your billing and to be reasonable in your charges. The chiropractor spent little time with the patients and there was nothing "custom" about the belt.  The fact that the chiropractor designed the belt did not make it a custom back brace.  The brace needed to be customized to each patient to be billed as a custom back brace.  That wasn't done.  More importantly, the chiropractor's belt was a fairly simple device made of leather, plastic and Velcro.  The incredible markup is why the chiropractor was prosecuted and convicted.  When billing, providers should regularly ask whether the amount charged seems reasonable for what is being delivered.  Medical ethics and the licensing laws of most states prohibit physicians from overcharging patients.  If you cannot defend your charges, you could end up like the chiropractor.  The second lesson is the need to keep track of the free goods and services you give to patients. It was the combined retail value of the goods given that led to the conviction on this count. Conducting occasional audits of your practice operations is a good way to prevent the pain and cost of government investigations and prosecutions.

Tom Conley