How Can Chiropractors Minimize the Chances of Being Targeted for Criminal Investigation for Health Care Fraud?

The answer is four fold in order of importance:

1)  Maintain good records;
2)  On some periodic basis, voluntarily submit to a health  care billing compliance audit conducted by a qualified compliance officer;
3) Associate with qualified office staff;    
4) Maintain professional relationships with all employees and medical associates.

Sounds easy, but it’s not.  Like a diet, the rules are simple, but often difficult to apply over the long haul.  Insulating oneself from criminal investigations in the midst of increasingly aggressive but wrong-headed prosecutions requires a no-excuses approach that measures success against a negative outcome.  In other words, it works, if you don’t get targeted for investigation.  But, without being targeted, you’ll never know whether all your efforts ever prevented a single investigation.  So, you might wonder, with no way to ever truly measure the success of your labors, why make any efforts?  Well, because there are side benefits to these basic efforts that will streamline your practice and make it more efficient and successful.  You will become a more disciplined and better professional.  And you will make more money.

1. Maintaining good records is more than employing a good office manager.  It means you must document, document, document.  These are the three “D’s”; forget about the others.  Discipline yourself so that, when in doubt, you  document.  Strive to reach the point in your practice where documenting your services—treatment, history, or mental notes—becomes as second nature as thinking about your patients’ problems.  Simply put: More is better; less is worse.  There are untold numbers of chiropractors who were either targeted or had investigations go haywire because of failing to properly document their treatment records.  And it’s good for your practice.  It provides you and others an ever-ready road map for efficient treatment.  It insulates you from complaints, no matter the origin—a patient, insurance company, employee, or cop.  And, don’t forget a back up to the records.  You need to put these records on disc every so often, in the event of fire or other damage.

2. Once every year or so, submit to a voluntary health care billing audit.  There are qualified personnel across the country, individuals who will come into your office and provide you with a business physical.  It’s no more discomforting than submitting to a urine or blood sample.  After a day or so, it’ll be over.  The cost isn’t so bad.  You will get a written report of some type.  Hire an attorney to maintain the reports for you so that any identified problems will remain private and privileged.  Read the report and implement at least some of the suggestions.  There is no better defense to the prevention of bad stuff.  It’s like taking a flu shot.

3. Do not associate with unqualified medical personnel,  at your office or elsewhere.  Of course, it may take some time to discover.  If so, once it becomes known, remove yourself from the situation, whether by firing, hiring, or fleeing.  Guilt by association is alive and well in health care fraud prosecutions.  One can  be  both courteous and firm when it comes to protecting a career.  Protect yours.

4. Finally, maintain professional relationships with employees and medical associates.  This means more than simply smiling and saying good morning.  Do not become involved in a side business deal or investment interest with any such person.  Limit your business deals with employees and medical associates to those involving your chiropractic practice. Play the stock market with someone else.  Invest in someone else’s real estate venture.  And, if a business arrangement limited to your chiropractic practice sounds too good to be true, well, it probably is.  So get some professional advice before you do it.  It’s better to pay a few hundred dollars now, to make sure everything’s on the up and up, than to struggle later trying to pay attorneys to fix problems you could never imagine were even possible.

Larry Economos, a civil and criminal defense attorney whose practice focuses on federal health care fraud defense, is a managing partner with Mills & Economos, LLP. Mr. Economos can be contacted via his website address,, or by telephone at 800-456-0460, 704-375-9913, or 252-752-6161.

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