Peer Review, Collections and Complaints ... Oh My!

Billing complaints, online marketing complaints, audits (most recently Medicare) and complaints based on peer review are of increasingly concern for D.C.s.

Risk Management

Peer Review, Collections and Complaints ... Oh My!

Attorney Jenn Herlihy has been representing chiropractors in malpractice actions or board complaints for many years. In her experience, billing complaints, online marketing complaints, audits (most recently Medicare) and complaints based on peer review are of increasingly concern for D.C.s.


Attorney Jennifer Boyd Herlihy recommends the following to counter the following types of board allegations:

Collection agencies. More complaints against D.C.s are being triggered due to the actions of their hired collections agencies. You need to know what these agencies are saying and doing on your behalf. Otherwise, it may lead to a board complaint against you! I recommend you find out what the agency will be communicating with your patients, e.g., the initial contact letter and any follow-up correspondence for nonpayment. Keep copies of these documents in your files.

Outside billing. If you don’t do in-house billing and provide a signature or signature stamp, which I do not recommend, you need to review bills for accuracy. At minimum, review a random sample at regular intervals. Further, know the codes for billing. 

Payment discounts. If you have a “prepay discount” package or similar plan, check your state’s board guidelines to determine if it’s appropriate. If so, have a documented policy that is clear to the patient. It needs to be fair and followed to the letter of the agreement.

Online marketing. Although programs such as Groupon look like great marketing opportunities on the surface, the problem is that the company shares in the sales. Thus, most states consider these offers to be fee-splitting, and therefore, illegal.

Medicare payments. Providers are now being audited on past records, so even if your system is now compliant, you could receive repayment requests.

Peer review. Many states consider conducting a peer review as practicing chiropractic. Some states go as far as mandating licensure and limiting the percentage of your practice devoted to this activity. Review the regulations and adhere to any expert requirements for your state.


The information in the NCMIC Learning Center is offered solely for general information and educational purposes. It is not offered as, nor does it represent, legal or professional advice. Neither does this information constitute a guideline, practice parameter or standard of care. You should not act or rely upon this information without seeking the advice of an attorney familiar with the specific legal requirements of the state(s) in which you practice. If there is a discrepancy between the site and an insurance policy you have with NCMIC, the policy will prevail.