News Briefs
The OIG recently audited an independent diagnostic testing facility in California and found that it violated Medicare’s ban on billing the program for diagnostic tests that chiropractors ordered. Medicare only allows radiologists and other physicians to seek payment for interpreting x-rays that chiropractors use to correct a subluxation. The OIG recommended that the facility refund Medicare over $88,000 in billings submitted from 2001 to 2003. The facility concurred with the OIG’s report. CMS has launched a 2-year demonstration project in certain states to allow chiropractors to bill for x-rays, CTs and MRIs (see June 2005 Bulletin). However, that does not affect the Medicare payment restrictions for radiologists who interpret chiropractor-ordered diagnostic services. ACR members should consult with their practice managers and contact the Economics and Health Policy Department with any questions.
Another managed care company has resolved a major class-action lawsuit. WellPoint, Inc. announced it will pay about $198 million to settle claims by physicians that it and other managed care companies violated federal racketeering and state prompt-pay laws. WellPoint will set up a $135 million physician compensation fund, pay $58 million in the physicians’ legal fees and contribute $5 million to a foundation to increase quality of care for disadvantaged and underserved patients. A key part of the settlement will force WellPoint to change its business practices to cut physicians’ overhead costs and their time spent fighting claims denials. WellPoint is the fifth managed care provider to settle long-standing allegations, joining CIGNA, Aetna, Health Net, Inc. and Prudential Financial, Inc.
