Forensic Chiropractic Consulting: Beyond the Courtroom
By Scott D. Misek, DC, CHCQM, FABQAURP
When people hear the term forensic, they often associate it with criminal investigations or the examination of deceased individuals. In my experience, the broader application of forensic principles to chiropractic practice is not always well understood, even among professionals involved in litigation, insurance investigations, and regulatory matters.
Forensic chiropractic consulting involves applying specialized chiropractic knowledge, professional experience, and investigative methods to questions arising in legal, regulatory, and insurance settings. While expert witness testimony is one application, the work extends well beyond the courtroom.
Throughout my career, I have encountered attorneys, insurers, and regulatory professionals who have limited experience identifying appropriately qualified chiropractic experts. Some turn to local practitioners because they are unfamiliar with the specialized training and investigative experience available within the profession. Yet there can be an important distinction between a clinician offering an opinion and a forensic examiner developing conclusions through a structured investigative process.
Beyond a Clinical Opinion
Clinical experience provides an important foundation for forensic consulting, but experience alone does not necessarily establish the ability to conduct a comprehensive forensic evaluation.
I have reviewed expert reports in which substantial clinical documentation was examined, only to be followed by a broad conclusion that all care was reasonable and appropriate. Conversely, I have encountered reports concluding that treatment was unsupported, without explaining the basis for that determination.
In either situation, the concern is not necessarily the conclusion itself, but the absence of a clearly articulated rationale.
A forensic opinion should be more than an expression of personal philosophy or preferred treatment methods. It should reflect a systematic examination of the available evidence, applicable professional standards, and the specific questions presented.
Documentation is central to that process. Although the absence of documentation does not necessarily mean an event never occurred, an examiner cannot simply assume that undocumented findings, conversations, or services took place.
Equally important is recognizing when information is incomplete. Before reaching a final conclusion, I make reasonable efforts to determine whether additional relevant documentation is available. My opinions identify the materials reviewed and acknowledge that new evidence may warrant further evaluation or modification of those conclusions.
Regulatory Investigations and Professional Accountability
Forensic chiropractic consulting also plays an important role in regulatory investigations involving professional conduct, ethics, scope of practice, and standards of care.
During my service as Chairman of the Nebraska Board of Chiropractic Examiners and as an investigative consultant to the Board, I encountered matters requiring examination of far more than the clinical appropriateness of treatment.
Regulatory investigations may involve patient complaints, allegations of professional boundary violations, conflicting testimony, and questions concerning statutory or regulatory obligations.
These matters often require examining clinical documentation alongside complaints, testimony, investigative reports, and the laws or regulations applicable to the circumstances.
Professional boundary investigations can be particularly challenging. Allegations involving personal relationships or inappropriate conduct may depend on competing accounts and evidence that extends beyond the treatment record.
Each allegation must be considered individually. The investigator's responsibility is to evaluate the available information and determine what it supports, rather than assume that an allegation establishes misconduct.
Professional expectations may evolve over time. When evaluating an allegation, I consider the standards and requirements applicable to the circumstances, including the period in which the alleged conduct occurred. A difference in clinical judgment does not automatically establish a departure from an accepted standard.
Insurance Investigations: Peeling Back the Layers
I have often described insurance investigations as being similar to peeling an onion.
An assignment may initially involve a question about medical necessity, treatment duration, or anticipated future care. However, as the investigation progresses, additional concerns may emerge involving documentation, coding, billing, or patterns of treatment.
A comprehensive evaluation may require comparing clinical records with the services billed, reviewing applicable payer policies, and determining whether the documented findings support the treatment provided.
In some investigations, I have identified recurring patterns involving similar treatment recommendations, documentation, and billing practices across multiple patients, despite differences in their documented clinical needs.
Such patterns do not automatically establish improper conduct, but they may warrant closer examination.
It is also important to distinguish inadequate documentation, medically unnecessary services, wasteful practices, abusive billing, and suspected fraud. These are not interchangeable conclusions.
Findings involving documentation deficiencies, questionable billing, or potentially unnecessary services should not automatically be characterized as fraud. Any determination involving fraudulent conduct must be evaluated against the applicable legal requirements and supporting evidence.
The examiner's responsibility is to identify and explain the findings, including their limitations, rather than assign conclusions that the evidence cannot support.
Objectivity Throughout the Investigation
One principle I have consistently emphasized in my forensic work is the importance of remaining objective.
For me, objectivity is not simply a consideration when writing the final report. It begins before accepting the assumptions underlying an assignment, continues throughout the investigative process, and remains important after professional conclusions have been reached.
An examiner must be willing to recognize evidence that supports or contradicts the original allegation. Personal treatment philosophies, professional preferences, or the expectations of the retaining party should not determine the outcome.
Maintaining that independence requires discipline, particularly when findings do not support the position of the party requesting the evaluation.
The objective is not to produce a favorable opinion. It is to provide an accurate, understandable assessment of what the available evidence supports.
The Value of a Defensible Conclusion
The value of forensic chiropractic consulting lies not simply in the opinion rendered, but in the methodology used to reach it.
A well-supported report should allow the reader to understand the findings, follow the reasoning, and identify the evidence—or absence of evidence—underlying each conclusion.
Whether a matter involves deposition preparation, trial testimony, settlement considerations, regulatory proceedings, or the possibility of further investigation, the retaining party should have a clear understanding of what the findings establish and where uncertainty remains.
Ultimately, my goal is to provide independent professional conclusions that can withstand careful examination and give those relying on my work a reasoned foundation for determining their next steps.