Fourteen Months Past Renewal and Sixty Unlicensed Visits
Dr. Brooks held a Missouri chiropractic license that came up for renewal on January 31, 2023. She did not renew. Between February 2024 and April 2024 she saw 60 patient visits at $65 each and continued to display her license and use the title “Dr. Brooks, DC.” She completed 18 hours of continuing education: 8 hours in practice marketing, 6 hours in x-ray technique, and 4 hours in ethics. In April 2024 she received a letter from the Board stating that her license had lapsed. She wants to pay the renewal fee, have the license backdated to January 31, 2023, and continue seeing patients immediately because several are mid-treatment. Her office manager has already submitted insurance claims listing her as licensed during the gap.
1. Identify the violations and explain whether the Board can backdate the license.
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The central violation is practicing chiropractic without a current license after January 31, 2023. Seeing 60 patients and using the title while lapsed supports unlicensed-practice allegations. The insurance claims create a separate risk: billing for services while representing herself as licensed may support fraud or false-billing allegations, even if the care itself was competently delivered. The continuing education is also deficient. Missouri chiropractic renewal requires a defined number of CE hours per renewal period, commonly 32 hours per biennium, with limits on certain categories; 18 hours, including 8 hours of marketing, is unlikely to satisfy the requirement as presented. The Board generally does not backdate a license to erase a lapse. A license is a status conferred prospectively; paying a fee later does not retroactively authorize the earlier practice. At most, the Board may determine when a reinstated license becomes effective. The correct assumption is that the gap remains a disciplinary issue.
2. What steps must Dr. Brooks take before lawfully resuming practice?
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She must stop seeing patients immediately. She should contact the Board, confirm whether her status is late renewal or reinstatement, and obtain the exact application requirements in writing. She will likely need to submit a reinstatement application, pay renewal and late or reinstatement fees, document completion of the required CE, and satisfy any additional conditions the Board imposes. Depending on how long the license has been lapsed and the Board’s rules, she may need to take or retake a jurisprudence examination, provide explanations for the lapse, and disclose the unlicensed practice. She should not submit insurance claims for the gap period as though she were licensed. She should also notify her malpractice carrier and seek advice about the claims already submitted. Only after the Board issues a current license should she resume patient care. If the Board permits a restricted or probationary license, she must comply with those terms.
3. How should the Board treat the 60 visits?
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The Board should treat the 60 visits as evidence of unlicensed practice, not as a harmless administrative oversight. The Board can consider the length of the lapse, the number of patients, the billing, the use of the title, and whether patients were harmed. It may issue a cease-and-desist letter, open a disciplinary case, impose a civil penalty if authorized, and require restitution or other corrective action. It may also refer the insurance-billing issue to the appropriate fraud unit. The Board should evaluate whether Dr. Brooks cooperated, whether she self-reported, and whether she continued practicing after notice. A consent order might include a reprimand, probation, fines, additional CE, and a requirement that she not repeat unlicensed practice. The Board should not simply accept a late fee and ignore the gap, because that would undermine the licensing system and give a competitive advantage to a licensee who practiced without a license.