Associate Pressured to Bill Services Not Rendered
A newly licensed chiropractor joins a busy Manchester practice as an associate. The owner tells her to document 'manual therapy, 30 minutes' for every patient, even when the associate performs only a 10-minute adjustment and no manual therapy. The owner also instructs her to add 'neuromuscular re-education' to every claim and to sign the owner's name on progress notes when the owner is out of town. The associate notices that the owner backdated a treatment note after an insurer requested records. The associate is still within her first year and worries that reporting will end her employment and that she may be implicated because she signed some claims. She asks whether she must report, to whom, and what the Board would do if it learned of the pattern.
1. What are the associate's professional and legal obligations when asked to document and bill services not rendered?
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Obligations:
- Do not document or bill services not rendered. 'Manual therapy, 30 minutes' when only a 10-minute adjustment occurred is a false record and a false claim.
- Do not sign another provider's name or backdate notes. Those are independent violations.
- The associate should object in writing, keep copies of the requests, and correct any claims she knows are false.
- Reporting internally may not be enough because the owner is the problem; she may need to report to the Board and, if Medicare, Medicaid, or insurers are involved, to the appropriate fraud unit. Board rules on unprofessional conduct and insurance fraud apply.
- She should consult counsel before making disclosures and avoid altering original records.
Fear of losing the job does not justify participating.
2. Does the associate have exposure for claims she signed, and how should she mitigate it?
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Exposure:
- Signing a claim or note is an attestation. 'I was told to' is mitigation, not a complete defense.
- If she signed false claims, she should self-report to the Board and the insurer, cooperate, and document that she was an associate under pressure.
- She should not backdate or destroy records; preserve emails and texts with the owner's instructions.
- The Board will distinguish the owner as the architect from the associate as the implementer based on knowledge, control, duration, and cooperation.
Mitigation: early self-report, cessation of the conduct, restitution where appropriate, and testimony about the owner's instructions. The Board may still impose discipline, but the scope is likely narrower than for the owner.
3. Describe the disciplinary process and possible outcomes for the owner and the associate.
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Process:
- A complaint triggers Board review and investigation; the licensee receives notice and an opportunity to respond.
- The Board may resolve by settlement or hold a hearing with counsel, witnesses, and evidence.
- The Board must find a violation of RSA 316-A or Board rules.
Outcomes:
- Owner: likely serious sanctions-suspension or revocation, substantial fine, restitution, practice monitoring, and referral to fraud authorities-because of the pattern of false billing, backdating, and directing an associate.
- Associate: discipline may be mitigated by self-reporting, cooperation, and lack of control, but signing false claims can still lead to reprimand, fine, probation, and continuing education.
The Board will also consider patient harm and insurer losses.