Section R4-7-902. Unprofessional or Dishonorable Conduct

Unprofessional or dishonorable conduct, as used in A.R.S. § 32- 924(A)(5), means:

1.        Failing to disclose, in writing, to a patient or a third-party payor that the licensee has a financial interest in a diag- nostic or treatment facility, test, good, or service when referring a patient for a prescribed diagnostic test, treat- ment, good, or service and that the diagnostic test, treat- ment, good or service is available on a competitive basis from another provider. This subsection does not apply to a referral by one licensee to another within a group of licensees who practice together. This subsection applies regardless of whether the referred service is provided at the licensee’s place of practice or at another location.

2.        Knowingly making a false or misleading statement to a patient or a third-party payor.

3.        Knowingly making a false or misleading statement, pro- viding false or misleading information, or omitting mate- rial information in any oral or written communication, including attachments, to the Board, Board staff, or a Board representative or on any form required  by the Board.

4.        Knowingly filing with the Board an application or other document that contains false or misleading information.

5.        Failing to create an adequate patient record that includes the patient’s health history, clinical impression, examina- tion findings, diagnostic results, x-ray films if taken, x- ray reports, treatment plan, notes for each patient visit, and a billing record. The notes for each patient visit shall include the patient’s name, the date of service, the chiro- practic physician’s findings, all services rendered, and the name or initials of the chiropractic physician who pro- vided services to the patient.

6.        Failing to maintain the information required by subsec- tion (5) for a patient, for at least six years after the last treatment date, or for a minor, six years after the minor’s 18th birthday, or failing to provide written notice to the Board about how to access the patient records of a chiro- practic practice that is closed by providing, at a mini- mum, the physical address, telephone number and full name of a person who can be contacted regarding where the records are maintained, for at least six years after each patient’s last treatment date or 18th birthday.

7.        Failing to:

a.         Release a copy of all requested patient records under subsection (5), including the original or diagnostic quality radiographic copy x-rays, to another licensed physician, the patient, or the authorized agent of the patient, within 10 business days of the receipt of a written request to do so. This subsection does not require the release of a patient’s billing record to another licensed physician.

b.        Release a copy of any specified portion or all of a patient’s billing record to the patient or the autho-

rized agent of the patient, within 10 business days of the receipt of a written request to do so.

c.         In the case of a patient or a patient’s authorized agent who has verbally requested the patient record:

i.         Provide the patient record, or

ii.        Inform the patient or patient’s authorized agent that the record must be provided if a written request is made under subsection (7)(a) or (b).

d.        Return original x-rays to a licensed physician within 10 business days of a written request to do so.

e.         Provide free of charge, copies of patient records to another licensed physician, the patient, or the autho- rized agent of the patient in violation of A.R.S. Title 12, Chapter 13, Article 7.1.

8.        Representing that the licensee is certified by this Board in a specialty area in which the licensee is not certified or has academic or professional credentials that the licensee does not have.

9.        Failing to provide to a patient upon request documenta- tion of being certified by the Board in a specialty area or the licensee’s academic certification, degree, or profes- sional credentials.

10.     Practicing, or billing for services under any name other than the name by which the chiropractic physician is licensed by the Board, including corporate, business, or other licensed health care providers’ names, without first notifying the Board in writing.

11.     Suggesting or having sexual contact, as defined in A.R.S.

§ 13-1401, in the course of patient treatment or within three months of the last chiropractic examination, treat- ment, or consultation with an individual with whom a consensual sexual relationship did not exist prior to a chi- ropractic/patient relationship being established.

12.     Intentionally viewing a completely or partially disrobed patient in the course of an examination or treatment if the viewing is not related to the patient’s complaint, diagno- ses, or treatment under current practice standards.

13.     Improper billing. Improper billing means:

a.         Knowingly charging a fee for services not rendered;

b.        Knowingly charging a fee for services not docu- mented in the patient record as being provided;

c.         Charging a fee by fraud or misrepresentation, or willfully and intentionally filing a fraudulent claim with a third-party payor;

d.        Misrepresenting the service provided for the purpose of obtaining payment; and

e.         Charging a fee for a service provided by an unli- censed person who is not a chiropractic assistant under A.R.S. § 32-900 or for services provided by an unsupervised chiropractic assistant; and

f.         Repeatedly billing for services not rendered or not documented as rendered or repeatedly engaging in acts prohibited under subsections (13)(c) through (e).

14.     Failing to timely comply with a board subpoena pursuant to A.R.S. § 32-929 that authorizes Board personnel to have access to any document, report, or record main- tained by the chiropractic physician relating to the chiro- practic physician’s practice or professional activities.

15.     Failing to notify the Board of hiring a chiropractic assis- tant or to register a chiropractic assistant under R4-7- 1102 or failing to supervise a chiropractic assistant, under

A.R.S. § 32-900 that is supervised or employed by the chiropractic physician.

16.     Allowing or directing a person who is not a chiropractic assistant and who is not licensed to practice a health care

profession to provide patient services, other than clerical duties.

17.     Intentionally misrepresenting the effectiveness of a treat- ment, diagnostic test, or device.

18.     Administering, prescribing, or dispensing prescription- only medicine, or prescription-only drugs, or a prescrip- tion-only device as defined in A.R.S. § 32-1901 and pur- suant to A.R.S. § 32-925(B). This subsection does not apply to those substances identified under R4-7-101(13).

19.     Performing surgery or practicing obstetrics in violation of

A.R.S. § 32-925(B).

20.     Performing or providing colonic irrigation.

21.     Penetration of the rectum by a rectal probe or device for the administration of ultrasound, diathermy, or other modalities.

22.     Use of ionizing radiation in violation of A.R.S. § 32- 2811.

23.     Promoting or using diagnostic testing or treatment for research or experimental purposes:

a.         Without obtaining informed consent from the patient, in writing, before the diagnostic test or treat- ment. Informed consent includes disclosure to the patient of the research protocols, contracts the licensee has with researchers, if applicable, and information on the institutional review committee used to establish patient protection.

b.        Without conforming to generally accepted research or experimental criteria, including following proto- cols, maintaining detailed records, periodic analysis of results, and periodic review by a peer review committee; or

c.         For the financial benefit of the licensee.

24.     Having professional connection with, lending one’s name to, or billing on behalf of an illegal practitioner of chiro- practic or an illegal practitioner of any healing art.

25.     Holding oneself out to be a current or past Board mem- ber, Board staff member or a Board chiropractic consul- tant if this is not true.

26.     Claiming professional superiority in the practice of chiro- practic under A.R.S. § 32-925.

27.     Engaging in disruptive or abusive behavior in a clinical setting.

28.     Providing substandard care due to an intentional or negli- gent act or failure to act regardless of whether actual injury to the patient is established.

29.     Intentionally disposing of confidential patient informa- tion or records without first redacting all personal identi- fying patient information or by any means other than shredding or incinerating the information or record.

30.     Intentionally disclosing a privileged communication or document, or confidential patient information except as otherwise required or allowed by law.

31.     Having been diagnosed by a physician whom the Board determines is qualified to render the diagnosis as habitu- ally using or having habitually used alcohol, narcotics, or stimulants to the extent of incapacitating the licensee for the performance of professional duties.

32.     Committing a felony, whether or not involving moral tur- pitude, or a misdemeanor involving moral turpitude. Con- viction by a court of competent jurisdiction or a plea of no contest is conclusive evidence of the commission.

33.     Having an action taken against a professional license in another jurisdiction, any limitation or restriction of the license, probation, suspension, revocation, surrender of the license as a disciplinary measure or denial of a license

application or license renewal for a reason related to unprofessional conduct.

34.     Directly or indirectly dividing a professional fee for patient referrals among health care providers or health care institutions or between providers and institutions or entering into a contractual arrangement to that effect. This subsection does not prohibit the members of any regularly and properly organized business entity recog- nized by law from dividing fees received for professional services among themselves as they determine necessary.

35.     Failing to report in writing to the Board any information based upon personal knowledge that a chiropractic physi- cian may be grossly incompetent, guilty of unprofes- sional or dishonorable conduct, or mentally or physically unable to provide chiropractic services safely. Any person who reports or provides information to the Board in good faith is not subjected to civil damages as a result of reporting or providing the information. If the informant requests that the informant’s name not be disclosed, the Board shall not disclose the informant’s name unless dis- closure is essential to the disciplinary proceedings con- ducted under A.R.S. § 32-924 or required under A.R.S. § 41-1010.

36.     Violating any federal or state statute or rule or regulation applicable to the practice of chiropractic.

37.     Any act or omission identified in A.R.S. § 32-924(A).

Historical Note

Adopted effective September 9, 1997 (Supp. 97-3). Amended by final rulemaking at 14 A.A.R. 502, effective April 5, 2008 (Supp. 08-1).