Striking a Nerve

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Medicare does not pay for experimental or investigational procedures, treatments or alternative medicine. According to an article published by The Kansas City Star, a former chiropractor from Missouri was aware of that stipulation within Medicare policy, but nonetheless billed the government benefits program for more than $3 million in experimental procedures performed on patients with neuropathy.

According to the story, the former owner of a chiropractic office in Kansas City performed nerve block injections that were not medically necessary to many of his clinic’s patients, who happened to be Medicare beneficiaries. (That’s certainly convenient.) Over a three-year period of time, the former chiropractor received $879,582 for the unneeded services.

Further research revealed that the chiropractor’s clinic provided the nerve blocking procedure during a time when Medicare had no specific coverage guidelines for neuropathy treatments. Apparently, he didn’t investigate whether or not Medicare considered the treatment to be necessary for patients with neuropathy and billed Medicare even though the procedure was not supported by medical research. (Well, he had some nerve.)

The 59-year-old pleaded guilty to one count of health care fraud. He was sentenced to 15 months in federal prison for his fraudulent claims and surrendered his license to practice.

This former chiropractor’s illegal actions definitely struck a nerve with the government and probably his patients, as well. (Let’s hope he didn’t endanger any lives with the unnecessary treatment.) While neuropathy can cause the loss of sensation, it appears that this fraudster is going to feel the full effects of the painful reality that he is now considered a criminal.

Source: Today’s ”Fraud of the Day” is based on an article titled, ”Former Chiropractor Sentenced for Medicare Fraud,” published by The Kansas City Star on January 27, 2015.

A former Kansas City chiropractor was sentenced Tuesday to 15 months in federal prison for Medicare fraud.

Michael Kelly Miller, 59, was also ordered to pay $879,582 in restitution. Miller had pleaded guilty to submitting Medicare claims for nerve block injections and other experimental procedures that were not medically necessary or supported by medical research. Between February 2009 and December 2011 Miller billed Medicare more than $3 million and received nearly $900,000.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.