MD/DC arrangements subject to legal issues

Medical doctors and chiropractors may share care responsibilities and even work together. Learn about the legal issues that result.

Key Points

Here are some of the core legal issues professionals involved in MD/DC relationships need to be aware of.

Additionally, many states do not permit a chiropractor to employ a medical doctor and vice versa. That leaves essentially two types of models for consideration: direct employment and management.

In addition, many states have their own self-referral restrictions. Whether it is a single or multiple legal entity depends on factors such as the payer mix, state regulations, and the type of services provided.

For example, under applicable federal law, designated health services, which include physical therapy and diagnostic imaging, must be provided in the same office where patient care is provided. Moreover, a physician, but not a chiropractor, must be physically present in the office when the designated health services are provided to patients.

Additionally, the practice has to ensure that its physicians spend, on average, 75% of their total professional time working through the combined practice. MD/DC practices that don't require an MD often find adhering to state and federal requirements difficult because of applicable supervision requirements.

Combined practices have to be careful to guard against the regulatory assumptions about them. Nevertheless, conservative professionals can take many steps to thwart investigations:

MD/DC relationships are not new, but the full spectrum of regulatory compliance is essential to ensure a relationship's long-term viability. It simply isn't sufficient to focus on one or more aspects. Getting the entity and form of compensation right is just one part of a legally complex business arrangement. To serve physicians well, all facets of the arrangement must be viewed and cleared.

The authors, who have more than 45 years of combined healthcare legal experience, practice health law with The National Healthcare Law Firm in Delray Beach, Florida. Law Consult deals with questions on common professional liability issues. Unfortunately, we cannot offer specific legal advice. If you have a general question or a topic you would like to see covered here, please send it to

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