You’re Only One Mistake Away: Essential Risk Management Lessons for Every Chiropractor
Originally published: 2025-03-26
When Dr. Kate Dreher speaks, chiropractors listen—because what she shares isn’t theory. It’s the reality of what happens when good doctors make bad decisions—or no decision at all.
As a seasoned chiropractor and trusted Risk Management Advisor for the ChiroFutures Malpractice Insurance Program, Dr. Dreher has spent decades helping doctors avoid catastrophe, protect their licenses, and practice with confidence. In a recent live lecture, Dr. Dreher pulled back the curtain on the real risks chiropractors face today—and what they can do to stay protected.
This wasn’t a dry policy review. It was a firehose of truth.
🔍 Practicing Out of Bounds: Scope of Practice is the Line You Cannot Cross
Whether you're dabbling in telehealth, functional medicine, or IV nutrition, one truth stands firm: You can only practice where you are licensed. Dr. Dreher emphasized that offering care—even virtually—to patients in states where you’re not licensed is considered practicing without a license. The consequences? Loss of licensure, lawsuits, and more.
"Your license defines your scope. You cannot get creative with legal definitions and expect to be protected," she warned.
⚖️ Don’t Be the Deepest Pockets in the Room
One of the most urgent takeaways? Vicarious liability is real—and brutal.
From midwives and massage therapists to Botox providers and IV vitamin clinics renting office space, if it happens under your roof, you might be liable—even if you didn’t directly treat the patient. Dr. Dreher shared real cases where chiropractors were sued simply because an outside provider operated in their office space without proper insurance.
“Perception of control is enough to get you dragged into court,” she cautioned.
📋 Policies, Procedures, and Paper Trails
Office policies aren’t just for show—they are your legal safety net. From HIPAA compliance and consent forms to clearly defined employee expectations, everything should be in writing and signed annually.
Failing to define employee responsibilities—or enforce expectations—can quickly spiral into legal vulnerability.
❌ Don't Let Emotions Override Judgment
One of the more jaw-dropping stories? A well-meaning chiropractor who took custody of a patient’s baby to “help the parents get some rest.” As Dr. Dreher put it bluntly:
“You’re not a babysitter. That’s not just risky—it’s insane.”
From romantic relationships with patients to adjusting someone with serious vascular concerns without clearance, her message was clear: Protect your license by maintaining boundaries.
🧾 Medicare: You Can’t Opt Out, So Learn the Rules
Many chiropractors remain dangerously uninformed about Medicare. Dr. Dreher stressed that if you’re not enrolled as a provider, you cannot treat anyone over 65—period. She also clarified proper use of ABN forms and billing codes, debunking common myths that could result in federal penalties.
“Chiropractors cannot opt out of Medicare. That means in order to see any Medicare patient, you must be a provider for Medicare. Okay? You have your option to be participating or non-participating, but if you are not a Medicare provider, you can never see anybody over the age of 65, ever. Unless you want a $25,000 fine.”
📉 Dismissing Patients: Do It Right, Or Regret It
Whether a patient is rude, non-compliant, or seeking care elsewhere, knowing when and how to dismiss them is critical. Send a certified letter with proper documentation, offer referrals, and be clear. If done wrong, it could look like abandonment of care, opening you up to litigation.
“The dismissal—firing the patient—is the abandonment of care. So if you say, ‘I don’t ever want you in my office again,’ and I don’t give you three names of chiropractors in that certified letter, then I can be sued for abandonment. Yes. If I send you that certified letter and I tell you, ‘Look, we’re done,’ and they do it in a very nice, correct, diplomatic way and I give you the name of other chiropractors, I have not abandoned you.”
📦 Final Thoughts: Risk Is Everywhere. Prepare Accordingly.
Dr. Dreher's closing advice was a powerful reminder:
“Risk isn’t just about insurance—it’s about how you think, how you document, and who you allow into your world.”
The ChiroFutures Malpractice Insurance Program, founded by Dr. Matthew McCoy and Dr. Anthony Carrino, exists to support and defend chiropractors who are committed to practicing safely, ethically, and intelligently. Dr. Dreher’s work as their Risk Management Advisor is a cornerstone of that mission.
📲 Learn more, get covered, and explore risk resources at chirofutures.org
Because protecting your practice is just smart chiropractic.
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