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Federal Chiropractic Medicare Fraud Charges – What You Need to Know
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Federal investigators are prosecuting chiropractors for Medicare fraud at increasing rates. If your practice bills Medicare for chiropractic services, you need to understand what federal prosecutors are looking for. Here is the first thing you should know: chiropractic Medicare fraud prosecutions result in devastating federal prison sentences. Benjamin Tekippe received 7 years in federal prison for billing insurance for chiropractic services while he was on vacation in Aruba – and while he was incarcerated in Arizona and Washington. James Spina received 108 months – nine years – for operating a $20 million fraud scheme through multiple practices. These are not theoretical outcomes.
Welcome to Spodek Law Group. We handle federal healthcare fraud defense cases regularly, including cases where chiropractors first realize they are facing serious criminal exposure through exactly this kind of investigation. The second thing you need to understand is this: more than 80% of all Medicare payments for chiropractic services went toward medically unnecessary procedures according to the Department of Health and Human Services Office of Inspector General. Federal prosecutors view chiropractic billing as a fraud-prone sector – and they are targeting it aggressivly.
Heres something most chiropractors dont realize about Medicare billing rules. The paradox is brutal. Medicare only covers “active treatment” of spinal subluxation – treatment that provides “reasonable expectation of recovery or improvement of function.” Medicare does NOT cover maintenance therapy. Yet 40 to 47 percent of all paid chiropractic claims were for maintenance therapy. Nearly half of all chiropractic Medicare billing is for services Medicare dosent cover. The crime isnt treating patients. The crime is billing Medicare for treatment that was never medically necessary.
The Maintenance Therapy Trap
Heres the uncomfortable truth about maintenance therapy billing. The distinction between active treatment and maintenance therapy is the difference between legitimate billing and federal fraud.
Medicare only pays for treatment that improves function. Active treatment must provide reasonable expectation of recovery or improvement. Once a patient reaches maximum therapeutic benefit, continuing treatment becomes maintenance therapy. Medicare doesnt cover maintenance therapy. If your documenting improvement that isnt happening to justify continued billing, thats fraud.
40 to 47 percent of all paid chiropractic claims were for maintenance therapy. Past OIG work found that nearly half of all Medicare chiropractic payments went to services Medicare dosent cover. The majority of chiropractors billing Medicare are billing for services that should never have been reimbursed. The scale of the problem is staggering.
The 2024 improper payment data confirms the pattern continues. According to Medicare Fee-for-Service Supplemental Improper Payment Data, the improper payment rate for chiropractic services is 33.6 percent. Thats $178.3 million in projected improper payments. One third of all chiropractic Medicare payments are improper. Your claims are being scrutinized against these statistics.
Think about what that means for your chiropractic practice. If your billing Medicare for ongoing adjustments without documenting measurable functional improvement, your probly billing maintenance therapy. Medicare will recoup those payments. And if the pattern is systematic, federal prosecutors will characterize it as fraud.
The Billing Schemes That Destroy Practices
Heres something about chiropractic Medicare fraud that reveals how billing practices create criminal exposure. The schemes that seem clever become the evidence that proves intent.
Tekippe billed for services while on vacation in Aruba. The Louisiana chiropractor submitted thousands of false and fraudulent claims for services he purportedly provided while he was out of the office. He billed for treatments while incarcerated in Arizona and Washington. The claims showed treatment dates when Tekippe was physicaly incapable of providing treatment. He received 7 years in federal prison.
Musselman coded electroacupuncture as neurostimulator implantation. The Illinois chiropractor billed for placement of an electroacupuncture device – but she coded it as surgical implantation of a neurostimulator. The electroacupuncture procedure would not have been reimbursed at all. The neurostimulator coding generated substantial payments. The deception netted her over $2.5 million in fraudulent payments. She received 20 months in federal prison.
Services coded as performed by physicians when actualy performed by mid-level providers. Musselman submitted fraudulent claims indicating services had been performed by medical doctors when they were actualy performed by nurse practitioners and physicians assistants. The provider identity was false. The billing codes were false. The reimbursement was fraud.
Billing 98941 for every visit is intentional upcoding. If your billing the highest-level manipulation code for every patient encounter, regardless of how many spinal regions you actualy treated, thats upcoding. Auditors look for this pattern. The code requires treatment of three or four spinal regions. If your records dont support that level of treatment, every claim is false.
The Worst Improper Payment Rate in Medicare
Heres the irony that should terrify every chiropractor billing Medicare. Chiropractic services have the highest rate of improper payments among ALL Part B services.
Chiropractic is the most error-prone specialty in Medicare. According to CMS Comprehensive Error Rate Testing program, no other Part B service category has a higher improper payment rate then chiropractic services. 33.6 percent of all chiropractic claims are improper. Your specialty is the most targeted category in the entire Medicare program.
$178.3 million in projected improper payments. Thats the 2024 projection for chiropractic services alone. Nearly $200 million in Medicare payments to chiropractors that should not have been made. Federal investigators know these statistics. They are actively looking for the chiropractors responsible.
80 percent of Medicare chiropractic payments went to medically unnecessary procedures. A 2016 OIG report found that more then four out of five Medicare payments for chiropractic services were for procedures that werent medically necessary. The majority of the entire chiropractic Medicare program was fraud. That report triggered intensified enforcement.
2025 Medicare guidelines focus on preventing abuse. Medicare is implementing stricter rules. Billing for unneeded services is considered abuse. The documentation requirements are being enforced more rigorously. The statistical outliers are being identified and investigated.
The Cases That Show What Happens
If you think federal chiropractic Medicare fraud prosecutions are theoretical, look at what actualy happens to chiropractors when these schemes collapse.
Benjamin Tekippe received 7 years in federal prison. The Louisiana chiropractor solicited patients by offering “free” chiropractic massages. He billed their insurance for the massage which wasnt covered, then billed for multiple other services that were either not performed or not performed as billed. He submitted thousands of claims for services while on vacation in Aruba and while incarcerated. He was ordered to pay $753,794 in restitution.
James Spina received 108 months in federal prison. Nine years for operating a widespread healthcare fraud scheme through multiple practices. The New York chiropractor showed “little, if any, regard for which medical services or treatments were medically necessary.” The clinic existed to maximize reimbursements, not treat patients. He was ordered to pay nearly $20 million in restitution.
Carrie Musselman received 20 months in federal prison. The Illinois chiropractor defrauded Medicare and twelve other insurance companies out of more then $1.5 million. She coded electroacupuncture as neurostimulator implantation. She billed services as performed by physicians when they were performed by mid-level providers. She was ordered to pay $2.3 million in restitution.
Brown received 5 years and 10 months in federal prison. The Chicago chiropractor defrauded Blue Cross Blue Shield of $2.1 million. Nearly six years in federal prison for billing fraud. He was ordered to pay $2,088,884 in restitution.
Tefylon Cameron pleaded guilty to $14.9 million fraud scheme. The Georgia chiropractor owned or operated multiple DME companies and a cancer genetic testing company. She obtained doctors orders for orthotic braces without regard to medical necessity. She violated the Anti-Kickback Statute. Conspiracy to commit healthcare fraud carries up to 10 years. Conspiracy to violate the Anti-Kickback Statute carries up to 5 years.
Dennis Peyroux pleaded guilty to COVID-19 test fraud. The Louisiana chiropractor billed Medicare for over-the-counter COVID-19 test kits that were not requested or otherwise ineligible for reimbursement. He agreed to pay over $3.2 million in restitution. The government forfeited over $1 million seized from his bank accounts.
Peter Adamczak received a year and a day in federal prison. The Long Island chiropractor was convicted of healthcare fraud. Even a relatively short sentence means federal prison time. The “year and a day” designation has federal significance – it makes the defendant eligible for good time credit, which reveals how familiar federal judges are with sentencing chiropractors.
The Eck Brothers faced $3.4 million in restitution. Todd Eck and Bradley Eck pleaded guilty to healthcare fraud charges in Kansas. Both brothers faced maximum penalties of five years in federal prison. The family chiropractic business collapsed under federal prosecution. Siblings went from business partners to co-defendants.
Heres the uncomfortable truth about chiropractic fraud prosecutions. When federal investigators examine your billing patterns, they look for impossible service dates. They look for coding anomalies. They look for maintenance therapy without documented improvement. The gap between your documentation and reality becomes the evidence that convicts you.
These arnt unusual cases. They represent standard enforcement outcomes. The sentences reach nearly a decade. The restitution reaches tens of millions. The practices that seemed profitable collapse when investigation begins.
How Chiropractic Investigations Begin
Heres something about how these cases develop that should concern every chiropractor. Investigations often begin long before anyone contacts you.
Statistical analysis flags billing outliers. If your practice bills significantly more high-level manipulation codes then similar providers, thats flagged. If your patient retention rates suggest maintenance therapy patterns, thats flagged. If your documentation dosent support the complexity of services billed, thats flagged. Medicare data analytics identify statistical outliers. Outliers trigger investigation.
Impossible service dates prove fraud automaticaly. Tekippe billed for services while incarcerated. The dates on the claims made the fraud obvious. If your billing shows services on dates you were traveling, on vacation, or otherwise unavailable, those claims prove fraud without any additional evidence needed.
Documentation audits reveal maintenance therapy. Medicare auditors review your treatment notes. They look for documented functional improvement. If your notes show the same treatment month after month without documented improvement, thats maintenance therapy. Every maintenance therapy claim is a false claim.
Whistleblowers file qui tam lawsuits. Employees who witness billing fraud can file False Claims Act lawsuits and receive 15-30% of any recovery. That billing clerk who questioned your coding. That associate who refused to sign notes for treatments that didnt happen. They can become government informants with financial incentive to expose everything.
Insurance company investigators analyze patterns. Private insurers have Special Investigation Units. They compare your billing to similar practices. They identify statistical anomalies. The fraud referral to federal prosecutors often comes from private insurers, not just Medicare.
The Health Care Fraud Strike Force program targets chiropractors. Since March 2007, the Strike Force program has charged more then 5,800 defendants who collectively billed federal healthcare programs and private insurers more then $30 billion. The program operates in 27 federal districts through 9 strike forces. Chiropractic fraud falls squarely within their targeting criteria given the industrys highest improper payment rate.
National takedowns include chiropractors among defendants. The 2025 National Health Care Fraud Takedown resulted in charges against 324 defendants, including 96 licensed medical professionals. 49 defendants were charged in connection with over $1.17 billion in allegedly fraudulent claims. When the DOJ announces major healthcare fraud enforcement actions, chiropractors are regularly among those charged.
What You Cannot Do When Investigated
Heres what people do when they learn about chiropractic fraud investigations. They panic. They try to fix things. They make decisions that create additional criminal exposure.
Do NOT destroy or alter patient records. Treatment documentation, billing files, appointment schedules, travel records. Destroying any of this is obstruction of justice. The government probly already has copies through Medicare claims data and records subpoenaed from insurance companies. Destruction proves consciousness of guilt.
Do NOT backdate documentation to show improvement. If your treatment notes dont support the billing, your natural instinct is to add documentation showing improvement. Dont. Backdating records is additional fraud. Document creation dates can be forensicaly determined. The cover-up becomes additional charges.
Do NOT continue questionable billing practices. If your billing maintenance therapy as active treatment, stop. If your upcoding manipulation services, stop. But dont try to “correct” past billing by creating false documentation. Thats additional fraud.
Do NOT assume the audit will go away. Chiropractors often think Medicare audits are routine. They think cooperation will resolve everything. By the time federal investigators contact you, the audit phase is over. They have evidence. They have statistical analysis. They have billing patterns. You need an attorney before you say anything.
The False Claims Math
Heres something about chiropractic Medicare fraud that exponentialy increases legal exposure. False Claims Act penalties apply per claim – and every adjustment is a seperate claim.
How the multiplier works. Each false claim carries penalties of up to $27,894. A chiropractor seeing 20 patients per day creates 20 potential false claims per day. Over a year, thats over 5,000 claims. At maximum penalties, thats theoretical exposure exceeding $139 million from False Claims Act liability alone.
Healthcare fraud adds criminal exposure. 18 U.S.C. 1347 provides up to 10 years imprisonment per count of healthcare fraud. Wire fraud adds up to 20 years per count. Anti-Kickback violations add up to 10 years per count plus $100,000 fines. The civil penalties stack on top of criminal sentences.
Treble damages multiply everything. False Claims Act provides for treble damages – three times the amount defrauded. If your billing fraud cost Medicare $500,000, treble damages equals $1.5 million. Plus per-claim penalties. Plus criminal fines. Plus restitution. The exposure compounds rapidly.
Mandatory exclusion from federal healthcare programs. Conviction for healthcare fraud triggers mandatory exclusion from Medicare and Medicaid. You cannot bill federal programs. You cannot work for employers who bill federal programs. Your career as a chiropractor treating Medicare patients is over. Even if you avoid prison, the exclusion destroys your practice.
Civil monetary penalties compound criminal exposure. The Office of Inspector General can pursue civil penalties seperate from criminal prosecution. Up to $50,000 per kickback under the Civil Monetary Penalties Law. Plus treble damages. Plus permanent exclusion. Even if you avoid prison, the civil liability can bankrupt you.
Corporate integrity agreements impose ongoing monitoring. Settlement often requires a 5-year corporate integrity agreement. Quarterly reporting to OIG. Independent review organization audits. Compliance program requirements. Annual certifications by the chiropractor personally. The settlement resolves past liability but creates ongoing compliance burdens that last for years. Violation of the agreement triggers additional penalties and potentialy exclusion.
State licensing consequences compound federal penalties. Healthcare fraud conviction triggers mandatory reporting to state licensing boards. Most states require disclosure of federal convictions. License suspension or revocation often follows. Even if you serve your sentence and pay restitution, you may lose the ability to practice chiropractic entirely. The federal conviction destroys both your federal billing privileges and your state license.
What You Should Do Right Now
If federal investigators have contacted you about chiropractic Medicare billing, or if your billing practices might trigger scrutiny, heres exactly what you should do:
Contact a federal healthcare fraud defense attorney immediatly. Not a general business lawyer. Not your malpractice carrier. Someone who specificaly handles federal healthcare fraud cases and understands Medicare chiropractic billing prosecution.
Do NOT speak to investigators without counsel. Federal agents may approach you or your staff for “voluntary” interviews. There is nothing voluntary about it. Anything said can be used to build the case against you. Politely decline and contact an attorney immediatly.
Preserve all documentation exactly as it is. Patient records, treatment notes, billing files, appointment schedules, travel records. Do not alter, destroy, or organize anything. Document preservation is critical.
Identify all potentially problematic billing patterns. Maintenance therapy billed as active treatment. High-level codes billed for low-complexity services. Services billed on dates you were unavailable. Your attorney needs to understand the full scope.
Do NOT discuss the investigation with staff or colleagues. Anyone you talk to can be compelled to testify. They may already be cooperating with the government. Only attorney-client communications are protected.
Todd Spodek tells every chiropractor in this situation the same thing: federal chiropractic Medicare fraud investigations are serious criminal matters. Benjamin Tekippe got 7 years for billing while on vacation. James Spina got 9 years for showing no regard for medical necessity. Your response in the next few days could determine wheather this becomes a matter that resolves favorably – or federal charges that destroy your practice and your freedom.
Call Spodek Law Group at 212-300-5196. Before you speak to federal investigators. Before you make decisions that create additional criminal exposure. Before a billing practice becomes a federal fraud prosecution.
Federal chiropractic Medicare fraud is an enforcement priority. Medicare auditors are actively analyzing your billing patterns right now. The sentences reach nearly a decade. The restitution reaches millions of dollars in payments. What you do right now matters enormosly.