The Assistant Who Adjusts and the Billing Under Dr. W.'s NPI

The Board licenses individual chiropractors, and the core acts of chiropractic practice-diagnosis, determination of a treatment plan, and spinal adjustment-are not delegable to an unlicensed person. An assistant may perform limited supportive tasks only if Board rules permit them and only under the required level of supervision. Applying ultrasound may be supportable as a modality if the chiropractor has examined the patient, established the plan, and is physically present or available to the degree the rules require; a phone check-in from another office is unlikely to satisfy direct supervision for modalities with risks. The nephew's performance of cervical and lumbar adjustments is unlicensed practice. His diagnosis of sciatica is also outside an assistant's role because it involves clinical judgment and diagnosis. The 40-hour online certificate does not create a license or expand the scope of practice. Dr. W. is responsible for the delegation and for permitting an unlicensed person to perform licensed acts.

Billing an insurer under Dr. W.'s NPI represents that Dr. W. rendered or supervised the billed service. If the nephew performed adjustments while Dr. W. was off site, the claims are false or misleading, regardless of whether the clinic actually provided some service to the patient. This can violate insurance fraud laws, the Board's prohibition on dishonest or unprofessional conduct, and payer contracts. The Board should obtain the claims, schedules, and patient records to compare the billed dates and providers. Consequences may include repayment, civil penalties, exclusion from payer networks, and licensing discipline. Dr. W. should stop the billing immediately, audit all Saturday claims, correct or refund improper claims, and self-report to affected payers. He should not attempt to paper over the problem with retroactive supervision notes; creating records after the fact would compound the misconduct.

Dr. W. should suspend the nephew from all clinical contact, stop billing for services not personally rendered or properly supervised, secure the patient records, and notify his malpractice carrier and a health-care attorney. He should audit the 14 Saturday dates and identify every patient who received an adjustment or diagnosis from the nephew, then arrange appropriate follow-up by a licensed chiropractor. He should respond truthfully to the Board and provide the delegation policies, supervision records, and billing corrections. The Board may impose a reprimand, fine, probation with practice monitoring, restrictions on supervising assistants, suspension, or revocation if the conduct is severe or repeated. It may also refer the matter to insurance regulators or law enforcement. Because patient safety and billing integrity are both implicated, the Board will look closely at whether Dr. W. accepts responsibility and whether he has corrected the office practices.