Rules established by state agencies and chiropractic boards are the equivalent of law and they constitute legal guidelines under which doctors are permitted to practice chiropractic. If a doctor strays from, fudges or outright ignores their board's rules of practice, sooner or later they will find themselves subjected to sanctions for non-compliance. These sanctions are often enough to deny a doctor credentialing within managed care networks or impose substantial monetary penalties. I always advise doctors to read their state's chiropractic act and their board's rules of practice, go to a seminar where these rules are addressed and explained, or to get a qualified lawyer to explain them in sufficient detail. 

Doctors don't understand proper coding protocols and don't adequately document their services. I'm guessing that at least half of all of legal problems encountered by doctors are, in some way, attributable to failure to properly code and/or document services. It's a crime that chiro colleges don't place more emphasis on teaching proper CPT coding protocols and documentation. Failing to do either is an automatic disqualification from getting paid for services provided.

The chiropractic profession is experiencing a rash of post-payment audits by managed care companies in which the carriers are seeking refunds of hundreds of thousands of dollars due to improperly coded services and/or failure to adequately document services billed. There is little in the way of legal defense to these transgressions. Proper understanding of CPT and ICD-9 coding is essential in the current environment of insurance oversight.

More importantly, proper documentation of services is essential if the doctor wants to get paid or simply keep the money they has been paid. Improper or inadequate documentation is also a growing concern to state chiropractic regulatory boards. Such inadequate documentation can result in a post-payment audit claim for reimbursement, a lawsuit alleging fraud and potential criminal charges if there is an on-going pattern of such improper conduct. Improper coding, whether it be in the form of up-coding or un-bundling for a higher reimbursement rate, is an open invitation to civil or criminal sanctions.

There are any number of qualified experts teaching coding and documentation. However, there are a number of consultants who make money by teaching doctors how to work the system by abusing coding and documentation protocols. Learn which programs are legitimate and stay away from the scam artists.

Doctors are generally not aware of the legal distinctions between salaried-employee and independent-contractor status. Most doctors believe they can hire a new doctor or licensed provider, and simply treat the relationship as that of an independent contractor in order to avoid paying employment taxes. Be very careful in this regard, as the determination of the status of your new hiree is not necessarily your call. If the IRS chooses to audit the employment relationship, it has the authority to make its own determination of whether the hiree is a salaried employee or independent contractor. An incorrect choice by the doctor can result in the IRS requiring them to pay back income taxes, penalties and interest.

There are a number of basic rules that govern the determination of whether a new hiree is to be treated as a salaried employee or independent contractor. Generally the primary criteria considered by the IRS are: how much control does the employer have over the hiree's work; is the hiree paid through an hourly, weekly or monthly salary, or by a single payment upon completion of the job; is the hiree free to perform other jobs while working for the employer; and does the employer provide the hiree the office and tools to provide the services, or does the hiree provide their own tools. These are a few of the considerations that go into the equation in determining whether you have to treat your hiree as a salaried employee and pay his/her taxes (as well as provide whatever benefits are available to other employees) or treat the hiree as an independent contractor. Be aware of, and acknowledge, these facts when you make this call.

These are five of the most common legal problems faced by doctors of chiropractic. Good luck.

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Larry Laurent represents doctors of chiropractic. He is a member of the National Association of Chiropractic Attorneys and conducts seminars on chiropractic law issues. He is the founder of the Chiropractic Law Group, a consulting firm specializing in providing counseling services on chiropractic laws and regulations, business protocols, and practice organization and marketing strategies. He can be reached at or (512) 996-8844.