Unlicensed Assistant Performing Adjustments
Dr. B owns a chiropractic clinic in Wichita and employs a 'spinal technician' who completed an online course but holds no Kansas license. For three months, the technician performed 62 cervical and lumbar adjustments, often while Dr. B was at another office; the technician documented 'adjustment performed' and billed insurers under Dr. B's NPI. Dr. B learned of this when a patient's insurer requested records. He fired the technician, refunded two copays, and told the office manager to 'keep it quiet.' Two weeks later, the Kansas Board of Healing Arts sends a letter requesting Dr. B's records for six patients and an interview. Dr. B asks whether he must report the technician, whether he can simply send a written explanation without records, and whether the Board can discipline him for the technician's conduct. He has no prior complaints and a clean 12-year record.
1. Does Dr. B have a mandatory reporting obligation, and to whom?
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Yes. Kansas law imposes reporting duties on licensees in connection with unlicensed practice and certain violations of the Healing Arts Act. The Board of Healing Arts is the licensing and disciplinary authority for chiropractors, and it has investigative authority over both licensees and unlicensed practice. Dr. B should report the technician's unlicensed adjustments to the Board promptly, in writing, with dates, patient counts, billing information, and what he did when he learned of it. He should not speculate beyond what he knows, but he should not minimize the conduct.
Firing the technician and refunding two copays does not satisfy the reporting duty or erase the prior billing. Failure to report can itself be treated as a separate violation or as evidence of unprofessional conduct. If insurers were billed for services the technician performed, Dr. B should also address the billing through the insurers' compliance processes and legal counsel. 'Keeping it quiet' is the opposite of the required response; it converts an employee problem into a licensee-integrity problem.
2. How should Dr. B respond to the Board's request for records and interview?
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Dr. B should cooperate through counsel, not ignore the letter and not send a bare explanation. The Board's request is part of an investigation under the Healing Arts Act; the Board has subpoena power and can pursue the matter whether or not Dr. B cooperates. A written explanation without the requested records is likely to be treated as incomplete and can aggravate the case. He should preserve all records, including the technician's notes, billing records, schedules, and communications, and should not alter or backdate anything.
Counsel can help him produce the six patient records with appropriate redactions and authorizations, prepare for the interview, and assert available privileges. Due process under the Kansas Administrative Procedure Act generally includes notice of the charges, an opportunity to be heard, representation by counsel, and the ability to present evidence and cross-examine at a hearing. Cooperation, candor, and corrective action are mitigation; obstruction, late production, or inconsistent statements are aggravating. He should also determine whether his malpractice insurer provides coverage for licensing-board proceedings.
3. What disciplinary exposure arises from billing for unlicensed services and supervising unlicensed practice?
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The exposure is substantial. Grounds for discipline under the Healing Arts Act include aiding or abetting unlicensed practice, fraud or deceptive billing, unprofessional conduct, and failure to supervise ancillary staff. The technician's adjustments were not chiropractic services that could be billed under Dr. B's NPI merely because Dr. B owned the clinic. Submitting claims for those services can also create insurance-fraud exposure separate from the Board case.
The Board may impose public or private censure, probation with conditions, a fine, suspension, or revocation. A clean 12-year record is mitigation, not a defense, and the Board will weigh the number of adjustments, the duration, the billing, and Dr. B's initial instruction to keep quiet. Early self-reporting, full restitution, corrected claims, a written supervision policy, and verification of staff credentials can reduce risk. The technician should also be reported for unlicensed practice. Dr. B should not assume that refunding two copays resolves the billing problem; the insurers and the Board will look at all 62 encounters.