updated 6/21/2005 5:48:37 PM ET 2005-06-21T21:48:37

In one year, the government paid chiropractors for nearly $285 million in services that should not have been billed to Medicare, an inspector general's report said Tuesday.

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Since 2001, the year studied, the demand for chiropractic services has increased. To prevent abuses, caps should be placed on the number of times that Medicare could be billed for chiropractic services for a patient, Health and Human Services' inspector general said.

"The need for a more effective way to eliminate inappropriate maintenance payments is crucial," the report said.

The questionable payments in 2001 amount to $2 out of every $3 that Medicare spent on chiropractic services that year. The payments were improper because they reimbursed providers for treatments that failed to meet the government's criteria for medical necessity, or because providers lacked the proper documentation to prove the services were needed, the report said.

The American Chiropractic Association, noting that the data cited by the IG's office is four years old, said the government instituted new procedures last year designed to help chiropractors avoid improperly billing the government. Medicare will reimburse for manipulation of the spine that is designed to improve a chronic or acute condition, but it is not supposed to reimburse chiropractors for simply maintaining a health condition.

The vast majority of improper payments, or $251 million, was for maintenance, the IG said.

"The procedures were put in place not quite a year ago, and it's intended to address the very problem they're talking about in this report," said Thomas Daly, a lawyer with the association, which represents about 12,000 chiropractors. "They wouldn't have the statistics to report whether it's having an impact or not. That's why we're a little mystified why they didn't go into what's happening now."

Daly said the association disagreed with the IG's recommendation that the government cap the number of times that it will pay for chiropractic services.

"We think an appropriate test is whether those services are reasonable and necessary," Daly said.

The inspector general's office said taxpayers could realize significant savings from the caps.

"When chiropractic care extends beyond 12 treatments in a year, it becomes increasingly likely that individual services are medically unnecessary," the report said.

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