Federal Charges Against Chiropractors
Welcome to Spodek Law Group. Our goal is to give you the reality of federal charges against chiropractors - not the sanitized version you find on government websites, not the compliance training fiction, but the actual truth about what happens when the federal government decides your billing practices constitute fraud. This is the information that most practitioners never learn until the FBI is standing in their waiting room.
Here is what nobody tells chiropractors until federal agents show up at their practice: federal charges against chiropractors almost never involve patient harm. The overwhelming majority of cases are healthcare fraud prosecutions - billing decisions that you thought were standard practice, that insurance companies paid for years, that your colleagues taught you were normal. The government does not come after you because you hurt someone. They come after you because of how you documented treatment, what codes you used, which services you billed together.
And here is the devastating part that every defense attorney knows but most chiropractors do not learn until they are facing indictment: the insurance company that approved and paid your claims for a decade becomes the prosecution's star witness against you. Their payment is not evidence that you did nothing wrong. It is evidence that you "knew" what you were doing - because they paid you, and you kept doing it.
What 82% Unallowable Actually Means for Your Practice
Let that sink in for a moment. According to an audit by the Office of Inspector General, 82% of chiropractic services billed to Medicare were classified as "unallowable." Thats not 82% of fraud cases. Thats 82% of all chiropractic Medicare claims reviewed. The audit found an estimated $358.8 million in improper chiropractic billing in a single review period.
What does this actualy mean for you? It means that the billing practices you learned from mentors, from colleagues, from industry seminars - the practices that insurance companies have been paying for years - are exacty what federal auditors classify as improper. Your "normal" practice is thier "fraud pattern."
Think about that. If you bill Medicare and your doing what most chiropractors do, theres a statistical probability that most of your claims fall into what the government considers the fraud zone. Not because your trying to steal from anyone. But becuase the guidelines are confusing, the codes are complicated, and the practices that got approved yesterday are prosecutable today.
OK so why does this matter so much? Because prosecutors dont need to prove you intended to defraud anyone. They need to prove a pattern. And if 82% of the industry is billing in ways the goverment considers unallowable, then your pattern looks exactly like everyone elses pattern - which is exactly what they prosecute.
How Insurance Companies That Paid You Become Star Witnesses Against You
This is were it gets really disturbing. You submit claims. Insurance companies review them. They pay them. You think: if they paid, it must be acceptable. If there was a problem, theyd deny the claim or send a warning. You interpret payment as validation.
Heres the kicker - prosecutors interpret it the opposite way.
When the government builds a healthcare fraud case against a chiropractor, they dont argue that the insurance company made a mistake by paying you. They argue that the insurance companys payment proves you knew the billing was suspicious and you kept doing it anyway. The payment becomes evidence of a "scheme" rather then evidence of innocence.
As Todd Spodek explains to clients facing federal healthcare fraud investigations, this is the trap that catches most practitioners completly off guard. You spent years building a practice, getting claims paid, believing that insurance approval meant you were operating within the rules. Then suddenly that entire history of approved claims becomes the prosecutions case against you.
The logic works like this in the federal courtroom: You submitted claims. Insurance paid. You submitted more claims using the same billing patterns. Insurance paid again. A reasonable person would know that if the billing were improper, the insurance company would stop paying. Therefore your continued billing proves you knowingly submitted improper claims. Conviction.
This is not hypothetical. This is exactly how federal healthcare fraud cases are actually prosecuted.
The Maintenance Therapy Trap Nobody Explains
Heres were people get confused and its absolutly critical to understand this. Medicare covers chiropractic manipulation to treat spinal subluxations. But Medicare does NOT cover "maintenance therapy" - ongoing treatment that keeps a patient feeling good but isnt expected to result in further improvement.
Sound simple? Its not. Not even close.
The line between "active treatment" that Medicare covers and "maintenance therapy" that Medicare doesnt cover has no objective definition. CMS guidance says active treatment is care that is "expected to result in improvement" within a "reasonable and generally predictable period of time." But what is reasonable? What is predictable? Who decides when improvement has peaked and ongoing treatment becomes maintenance?
The prosecutor decides. After the fact. Based on your documentation.
Your patient has chronic back pain. You treat them. They feel better. You continue treating them becuase they report continuing improvement. You bill Medicare using the AT modifier that indicates "active treatment." But an auditor reviews your records two years later and determines that improvement "peaked" after session 12. Everything after that? Maintenance therapy. Fraud.
You didnt know where the line was becuase nobody knows where the line is. CMS wont tell you. Your billing consultant cant tell you. The only entity that gets to decide is the federal prosecutor reviewing your files looking for crimes.
Weve seen this pattern at Spodek Law Group dozens of times. The chiropractor genuinly believed they were providing active treatment. The patient reported feeling better with continued care. Insurance paid the claims. Then years later, an auditor declares it was all maintenance therapy that should never have been billed.
Thats not fraud in any meaningful sense. But its prosecutable. And prosecutors prosecute it.
What Federal Prison Actually Looks Like for Chiropractors
These arnt hypotheticals. These are real chiropractors, real sentences, real destroyed lives.
Carrie Musselman, Eureka Illinois. Sentenced June 2025. Twenty months federal prison. Ordered to pay $2.3 million restitution. Her crime? The government argued she submitted claims indicating services were performed by medical doctors when they were actualy performed by mid-level providers. She went to trial, lost after thirteen days, and watched her practice and freedom disappear.
Dr. Benjamin Tekippe, Louisiana. Sentenced September 2025. Seven years federal prison. $753,794 restitution. Six counts healthcare fraud, one count wire fraud. He owned Metairie Chiropractic & Rehab. The jury convicted him in April 2025. Thats seven years in a federal facility. Seven years away from family. Seven years destroyed.
James Spina, New York chiropractor. Nine years federal prison. Ordered to pay $9.76 million restitution and forfeit another $9.1 million. His practices submitted over $80 million in claims between 2011 and 2017. Insurance paid those claims for six years before they became the basis for his prosecution.
A Chicago chiropractor - sentenced November 2025 to nearly six years in prison, ordered to pay $2.1 million to Blue Cross Blue Shield. He submitted claims for services from 2016 to 2020. Insurance paid for four years. Then they helped prosecute him.
And then theres the California case - 54 years, eight months in prison for a $150 million workers compensation fraud scheme. The judge noted he "took advantage of that knowledge based on greed." Twenty three million dollars in fines. Fifty four years. For a chiropractor.
The sentencing range runs from probation to decades in prison. What determines where you fall? The amount of the alleged fraud. Your criminal history. Whether you went to trial or pled guilty. Whether you "cooperated" with investigators. Whether the judge wants to make an example.
Federal sentencing guidelines for healthcare fraud are brutal. Each healthcare fraud count carries up to 10 years. Each wire fraud count carries up to 20 years. Multiple counts run consecutively. Suddenly a five-year billing pattern becomes a potential life sentence.
Signs Your Already Under Investigation
By the time most chiropractors learn thier under investigation, the government has been building the case for eighteen months to three years. They dont send warnings. They dont give you a chance to explain first. They build the entire case behind your back before making contact.
But there are signs. Subtle ones. Easy to miss unless you know what to look for.
Former employees getting unusual phone calls. "Verification" calls from insurance companies that seem oddly detailed. Patients mentioning that someone called to confirm their treatment dates. These arnt routine audits - these are federal agents building a case.
Maybe your billing software vendor contacts you about an unusual records request. Or your bank mentions a subpoena for financial records. Or your accountant gets a call asking about your revenue patterns. Each of these alone might seem like nothing. Together they form a pattern - the pattern of federal investigation.
The HHS Office of Inspector General maintains whats called a "data analytics" program specificaly designed to identify chiropractors with suspicious billing patterns. Their algorithms flag practices that bill more services per patient then regional averages, that use certain procedure codes with unusual frequency, that show spikes in billing volume after adding new referral relationships. If your practice got flagged, an analyst is reviewing your claims history right now. You have no idea this is happening.
Strange requests for records from entities you dont recognize. Subpoenas going to your insurance companies, your banks, your referring providers - but not to you. The government can compel these third parties to produce records without notifying you. By the time you realize somethings happening, they already have everything.
Colleagues getting indicted for similar billing practices. If chiropractors in your region who bill similarly are facing federal charges, thats not random. Healthcare fraud strike forces work regionally. They identify patterns across multiple providers. If theyre prosecuting practitioners with your billing profile, your probably already on their list.
The 2025 National Health Care Fraud Takedown charged 324 defendants across 50 federal districts. This wasnt 324 separate investigations. This was coordinated enforcement targeting specific billing patterns across the country. If your billing matches those patterns, the question isnt whether theyre looking at you. Its when.
Why Fighting Healthcare Fraud Charges Fails 93% of the Time
Federal healthcare fraud conviction rates hover above 93%. Not becuase everyone charged is guilty. Because the system is designed for conviction.
The government has unlimited resources. You have whatever savings you can access after the asset freeze. They have years of preparation. You have weeks to respond. They have teams of prosecutors, FBI agents, forensic accountants, and expert witnesses. You have whatever defense you can afford.
Going to trial feels like the American thing to do. If your innocent, fight it. Let a jury decide. But federal juries in healthcare fraud cases almost always convict. The billing patterns are complicated. The regulations are confusing. The government presents it as "doctor stole from Medicare" and jurors believe it.
Even when the defense makes valid arguments - the guidelines were unclear, the billing practices were industry standard, the patient genuinly needed treatment - juries still convict. The prosecution has spent years making the case look simple. The defense has weeks to explain why its complicated.
And if you go to trial and lose? Sentencing is worse. Much worse. The "trial tax" in federal court is real. Defendants who plead guilty and "accept responsibility" get sentence reductions. Defendants who exercise their constitutional right to trial get hammered at sentencing.
The math is brutal. Plead guilty early with cooperation: maybe 18-24 months. Go to trial and lose: 5-7 years or more. The system punishes you for fighting.
What Can Actually Be Done
We're not going to tell you there are easy answers here. Federal healthcare fraud prosecution is the government at full force against individual practitioners. The conviction rate tells you the odds. The sentencing ranges tell you the stakes.
But there are things that can change outcomes.
Early intervention matters more than anything. If your under audit - not yet criminal investigation, but audit - the decisions made right now determine whether this becomes civil or criminal. Experienced healthcare fraud defense attorneys understand how to navigate the administrative process before it becomes a criminal one. Civil resolution means fines and compliance changes. Criminal prosecution means prison.
The quality of your defense counsel matters enormously. Healthcare fraud is a specialized area. The attorney needs to understand HCFA 1500 billing, Medicare regulations, state and federal criminal procedure, and the specific dynamics of healthcare fraud prosecution. They need relationships with the federal prosecutors and FBI agents who handle these cases. They need to know when to fight and when to negotiate.
Cooperation can reduce sentences - but it has to be the right kind of cooperation, at the right time, with the right protections in place. Poorly handled cooperation just gives prosecutors more ammunition. Talking to agents without counsel present, providing records without understanding what theyre looking for, making statements that seem innocent but create legal problems - these mistakes happen all the time becuase people dont understand how federal investigations work.
The timing of cooperation matters enormously. Cooperate too early and you give away leverage. Cooperate too late and the government has already made charging decisions. Cooperate poorly and you create obstruction problems on top of the underlying charges. This is why experienced counsel is not optional - its the difference between managing the situation and making it worse.
Heres the truth that nobody wants to say: the best outcome in most federal healthcare fraud cases isnt vindication. Its damage limitation. Its the difference between seven years and twenty months. Its the difference between losing your license and keeping it. Its the difference between bankruptcy and financial survival.
The federal government has decided that healthcare billing enforcement is a priority. The 2025 takedown charged 324 defendants for $14.6 billion in alleged fraud - more than double the previous record. Strike forces operate in 27 federal districts. A new Data Fusion Center uses algorithms to identify prosecution targets.
Theyre not slowing down. Theyre accelerating.
The Call You Need to Make
If your reading this at 11pm because something happened today - you received a letter, agents showed up, a colleague was indicted and you do similar billing - you need to understand that every hour matters.
The clock started when you learned about this. What you do in the next 48 hours determines whether you have options or dont. Whether your practice survives or doesnt. Whether you go to prison for years or months.
At Spodek Law Group, we handle federal healthcare fraud defense for practitioners across the country. We understand the billing complexities, the regulatory maze, the prosecution patterns. We know the federal prosecutors and FBI agents. We know what works and what doesnt.
This call costs nothing. Not making it costs everything.
212-300-5196
The government has been preparing for this moment for years. Its time you started preparing too.
Dont wait until the target letter arrives. Dont wait until your accounts are frozen. Dont wait until your license is suspended. The time to act is now - while you still have options, while damage limitation is still possible, while the difference between years in prison and months still exists.
They made their move. Whats yours?
