EPISODE 406: Legal Considerations for The Medically Integrated Clinic with Michael Silverman

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry. 

Welcome to another episode of Modern Chiropractic Mastery. Today, I've got Michael Silverman. He is a local attorney. And as you listen to us really dive into some of the details of considering an integrated, integrated practice, you know, realize there's different levels of having an integrated practice and, uh, you know, it can be small, medium and large in, in the way, in the scope you want to do things and the different types of providers.

And we're going to dive into some of that and some of the best practices. And obviously. Um, you know, you always want to have your own legal team when you're going to do something like this, but we wanted to dive into some of the things that you really got to start thinking about if you want to do this currently or into the future.

Uh, you will notice that Michael, like myself, is in Florida. And so we, we talk about Florida a fair amount, but a lot of it is applicable to your state or it'll give you the understanding of what you need to look at and see, [00:01:00] okay, yeah, my state. Differs here, right? And so you're going to be able to, uh, you know, transfer what we talk about sometimes here in the state of Florida to other states or give you the idea on what to think about.

And, um, you know, Michael and his team, uh, work directly with our state association a lot at conferences. That's how I first met his partner speaking, and they really have a wealth of knowledge in this field. And, uh, you're going to get a lot of great insights into this, uh, very. You know, it's, it's, it's a, a trend we're seeing in the profession.

And I think in the positive, uh, it's a, it's a great opportunity for many, uh, chiropractors. Uh, before we dive into that episode, uh, just want to check out our coaching program, you know, go to modern chiropractic, marketing. com. Uh, you can attach our team to yours. Uh, our signature program, uh, is coaching and it's also, uh, marketing done for you.

And so we attach our team, you know, you get a coach, you get a marketing coordinator. You get, uh, you know, other [00:02:00] ancillary advisors around you to help grow your practice and make 2025 a great year for that. So go to check out our coaching programs at modern chiropractic marketing. com. And feel like, uh, stop feeling like you're left on an Island and really help grow your practice with you.

We have over 50 clinics throughout the United States and UK under our program there. That's not including our mastermind, uh, clinics. And so we've, uh, And that's not including our chiropractic success academy. We're getting a lot of great results. We're changing practices. We're doing it ethically. And so maybe it's time to start investing in your future.

So check us out at modern chiropractic marketing. com. All right, without further ado, here is my interview with Michael Silverman.

Dr. Kevin Christie: All right, excited to have Michael Silverman on the podcast here. It's an attorney out of Florida. I'm going to let him dive into some more of the specifics of that, but we're going to have an interesting topic on compliance around integrated [00:03:00] clinics and even some things about W 2 versus ICs and just some of the legal matters that we need to consider.

We're seeing a lot of chiropractic practices integrate and, you know, One form or fashion, and I thought this was a, a timely discussion around this. But before we dive into it, Michael, uh, tell us a little bit about yourself personally and professionally.

Michael Silverman: First and foremost, Dr. Christie, thank you for having me here.

It's my pleasure to, uh, to come before you and your audience and have a chat on medically integrated chiropractic practices. Um, a little bit about myself, my background, I'm personally born and raised in a chiropractic household. So I got to, uh, you know, I got to grow up in that environment and really see my father, you know, back in the early nineties, make such a long lasting impression upon his patients.

He had one of the first medically integrated chiropractic practices down here in south florida. Um, in, in the early eighties and, um, you know, it was really just a matter of not being smart enough in my chemistries in order to [00:04:00] fall on his foot and step to be a chiropractor. So, my next best bet was to become an attorney who specialized in working with health care professionals and medical business owners.

My office is down here in South Florida. That's a law firm of Silverman Bain and. Um, just given the background and the environment that I grew up with, a large part of my practice is involved with working with chiropractic physicians in both stand alone practices and medically integrated practices. And, you know, speaking of the latter, it's, it's coming to be like Starbucks on every corner down here in South Florida with medically integrated practices.

So there's a, you know, there's a lot of do's and don'ts and I'm happy to be here with you and your audience to kind of chat about how folks can be best set up for success here.

Dr. Kevin Christie: Love it. Yeah. And, uh, you know, I first heard of your firm. Actually, I was at an FCA event and listening and it was your partner and she did a great job of, of talking about this subject matter.

And then ironically, you and I have a mutual friend. And so we had drinks and connected. And so it was kind of [00:05:00] came full circle there. And, uh, I really knew I needed to have you on, uh, to, to discuss this. And one of the things I just want to Uh, mentioned to our audience, you know, we're obviously you and I are both in Florida.

We're going to try to Navigate the fact that some things are state based. A lot of things are state based. Some things we'll talk about today will be federal And then some of the state based things will apply to your state as well. You just might need to Talk to your association things of that nature, right?

Absolutely,

Michael Silverman: and we'll do our best to point out what may be more state centric and what may be more No federally applicable to all folks

Dr. Kevin Christie: Yeah. And one of the things I wanted to start out with was just the idea that I know in, in our state, you have to be either a, a dc, an md, or a do to, to own a chiropractic practice.

Um, or, uh, you know, and I think that is in, in a lot of states, but obviously check that or there is the idea of the healthcare clinic license. Right. What, could you, could you bring that up a little bit and keep me up to [00:06:00] speed on that? Absolutely. It's

Michael Silverman: a great question, Dr. Christie. And, and, you know, before we talk about, I guess, who can own a medically integrated chiropractic practice, take a step back and who can own a chiropractic practice focusing on here in Florida.

Oftentimes folks will come to me and it's, you know, Hey, I'd like to open up a practice where I currently have a practice. It's me. I'm a Florida licensed DC, and I've got a New York licensed DC that I want to own or operate it with. Or I went into business with my brother in law here in the state of Florida.

Any business that employs a chiropractic professional pursuant to the Florida Board of Chiropractic Medicine requires that business to be owned as you mentioned, um, solely by an MD, DO or chiropractic physician or a conjunction of family members, immediate family members that are co owners. We're talking, um, you know, a father, a mother.

or one down, um, uh, a son or a daughter or a sibling again, I've had situations where it's a [00:07:00] brother in law and it doesn't pass muster and they're running afoul of these health care clinic and board of chiropractic medicine license requirements, which, which are a felony in Florida. And it's silly, right?

You, uh, you know, so. Um, one way if you are in business with somebody who is not a Florida, uh, licensed chiropractic physician is, is that healthcare clinic licensure that you mentioned, Dr. Christie, um, something that's not needed if you are wholly owned by a chiropractic physician and a family member or spouse.

But if you have somebody that falls outside that realm, that's where that healthcare clinic license would be required. And that's even just for our chiropractic practice before we dive into an integrated one.

Dr. Kevin Christie: Okay. And so then with the, the integrated one, what does that look like and how is that different mostly?

Michael Silverman: Okay. So, um, let's talk about kind of nationwide integrated practices and then we'll focus on Florida. So back a couple decades ago, the, the rule of the land nationwide was this [00:08:00] kind of corporate practice of medicine prohibition. And essentially that, that regulation stood for the fact that any corporation that is looking to provide medical services Has to be owned by a medical practitioner that can provide those medical services to try to take out any undue influence of, you know, corporation into medical care, right?

It, uh, you know, it certainly has its foundation and that from an ethical and medical appropriateness perspective, but that law of the land, while it's still steadfast in many states has slowly eroded over the past couple of years. It's still the law of the land in many states such as California and in New York.

But here in the state of Florida, there is no blanket prohibition on a lay person owning a medical practice. And so essentially, I myself, Michael Silverman, the non medical practitioner, medical professional. I can own a health care, a medical facility, a practice [00:09:00] in the state of Florida, chiropractic aside.

Um, and if that practice does not submit any claims for reimbursement, I don't even need any license or regulation. I don't even need this health care clinic license. If it's providing chiropractic services, I mentioned, you know, thanks to the board of chiropractic medicine and the good lobbying here, protecting chiropractors, not just anybody.

You can own that practice. You need that health care clinic license. But from a medical practice perspective, if it's just cash, no license needed. Um, however, if we're going to submit any claims for reimbursement in that medical practice, Medicare, TRICARE, CHAMPUS, or even PIP for that matter, or commercial insurance, there are regulations that say that everybody in the state of Florida that owns that type of practice needs a health care clinic license, unless an exception applies.

And you'll see today as we talk. Where there's a law, there's oftentimes, you know, 12 exceptions to the law, and the health care clinic license requirement is no different. And one of the exceptions that are [00:10:00] applicable to a chiropractor looking to medically integrate. There's a statutory exception under the Florida license that says you don't need this health care clinic license.

If it's 100 percent owned by the chiropractic physician or an MDDO or a spouse of the chiropractic physician, and there's going to be direct oversight by that chiropractic physician for the services that are going to be rendered in that type of situation, a health care clinic license may not be required.

It's a very intense factual specific scenario, um, and not having a health care clinic license is a third degree felony in the state of florida. As I mentioned, lots of different states have the analogs for the health care clinic license. So you really just want to dive in. Is there an analog and is it required for me?

Dr. Kevin Christie: Perfect. Love that. And so just to get that kind of squared away is that as a chiropractor, I could, uh, own a hundred percent of a medically integrated clinic. Um, obviously I couldn't render and we'll get to that, but I couldn't [00:11:00] render medical services outside of my scope of a chiropractor without the, uh, medical director or, you know, the like, uh, is that accurate?

Michael Silverman: That, that is absolutely correct. As a, as a, um, you know, again, the, the current statute on the books in Florida. And the impressions of that statute would exempt 100 percent chiropractic physicians looking to employ somebody to render those medical services with the health care clinic license in Florida.

There's something called a certificate of exemption. If you are exempt, you can either rest on your laurels and say, I'm exempt and do nothing, or you can proactively apply. To the agency for health care administration for a certificate of exemption from a health care clinic license. That's what I advise all of my clients because the current administration views the exception as applicable.

The next 1 may not. But if you apply for a certificate of exemption, it's it's 100 dollars. And you essentially say. Hey, Dr. Christie, the [00:12:00] owner of this practice, a hundred percent DC owned practice, and we're gonna employ an NP or PA to render medical services, and I want your blessing, and they'll go ahead and issue that certificate of exemption.

So that's certainly something to keep in mind as well.

Dr. Kevin Christie: Okay. So I could, that scenario, I could, I could employ W2 employee, uh, an MP or, uh, you know, something like that. That's not a, a doc. Um, if they are rendering services that are outside of my scope, do you then need the medical director on top of them?

Is that correct?

Michael Silverman: That's a great question. And I want to, I want to, um, make a distinction between the terms medical director and supervising physician because they're, they're oftentimes co mingled, but they're very distinct in the state of Florida. If you, if your business is required to have a healthcare clinic license, the one that I mentioned in Florida.

In order to apply for that license, you need a medical director and that medical director has to be somebody who can [00:13:00] oversee has the capacity to see the scope of services that are being rendered in the event that we decide, hey, we're exempt from that health care clinic license in Florida. Where you don't need it in another state in the state of Florida, you can bring on that nurse practitioner or that physician assistant and they essentially would have a supervising physician and MD or a D.

O. That's the distinction between supervising physician and medical director on the health care clinic license side and that supervising physician would provide. Indirect supervisory services. They don't have to be on site in Florida at the practice, but they essentially have a written and established protocol that they operate under.

Um, keep it on premises at the practice location. It says, you know, the NPA or the PA, they can provide these services, administer these treatments without consulting with that MDDO supervising physician. Otherwise got to consult with them if these other things arise.

Dr. Kevin Christie: Awesome. And then some variations of how you could, I guess, structure [00:14:00] that, uh, let's say the MD or DO, uh, theoretically you could, or legally you could have them as a partner in your business.

I would assume, um, you could have them as a W2 employee, I guess. And then could you also do independent contractor with that, that MD or DO? What are some of the structural things you're seeing with that to make sure you're able to have that nurse practitioner or physician's assistant to do injections and.

things of that nature that are outside of the chiropractor scope

Michael Silverman: generally on the supervising physician aspect of things, you'll have an independent contractor relationship with that practitioner because they're not on site. They're not devoting, you know, work on your, on your, um, practice on a, on a daily type of basis.

So that's generally what we'll see. Oftentimes when you engage. Either as an independent contractor or employee and NPR PA, they already have a supervising physician that they're working with. So that often is a pro to look out for. So you don't have to try to reestablish that [00:15:00] relationship. Maybe it doesn't cost you anything extra, you know, as far as compensation to that supervising physician backpedaling just a hair here on the supervising physician in the state of Florida.

Um, a couple of years back, APRNs, Advanced Practice Registered Nurses here in Florida have begun to enjoy autonomous practice where they do not need a relationship with a supervising physician for primary care services. So, if you find an APRN that is autonomously designated, they've done that registration here in the state of Florida, and you're going to be providing primary care services.

Then you don't even need to worry about that supervising physician relationship.

Dr. Kevin Christie: Yeah, that's really good. Maybe there's some other states that are offering that as well. So again, if you're in a different state, which I know many of you are, uh, look into that and again, just glean a lot of these ideas that are, that we're chatting about that could trigger a, uh, idea or thought.

And then you can check with your appropriate state laws. [00:16:00] All right, good. That was really helpful. Now, what are some of the limitations of that medical director slash supervising physician? What are, what are the requirements and limits you're seeing around that?

Michael Silverman: Great questions. And again, this is what we're going to want to check on a on a fact specific basis here in the state of Florida.

There are limitations both on the medical director side and the supervising physician side, obviously, first and foremost, for either of them, it has to be within the scope of practice of that supervising practitioner. Um, whether it's a specialty or otherwise that they've taken coursework on. So it needs to be within their scope of practice, depending on the types of services that are being rendered, there can be limitations on both the number of individuals that are being supervised, the mid level practitioners, as well as the number of clinics that are being supervised.

And we have to keep in mind that, um, being designated as the medical [00:17:00] director or a healthcare clinic license entity. Um, it creates obligations and liabilities upon that, that, um, M. D. or D. O. Statutorily here in the state of Florida, they need to be, you know, conducting systematic reviews of billings, for example, to to ensure that the buildings are not fraudulent or unlawful.

There's been a lot of allegations by many commercial insurance and PIP carriers in the state of Florida, a lot of lawsuits, allegations that the medical directors are really farces because they're not conducting the reviews that would be required in order to catch the fraud that these carriers are alleging.

And thus, they said that it was a sham health care clinic license relationship and and we shouldn't have paid you unless you had a health care clinic license. And thus, we want all that money back. So we have to make sure we're not just again, whether it's a medical medical director or supervising physician that you're not just throwing an aim on a piece of paper or your wall that they're actively actually doing what they need to do [00:18:00] to both protect their licenses and to help protect your business from, you know, that type of scrutiny.

Dr. Kevin Christie: Yeah, you were kind enough to send me some key information to help me prepare for this because I know it's going to be a lot of good substance to it. And one of the things you talked about was minimizing risk and having the appropriate written agreements, but also implementing an effective compliance program with this, uh, any.

Additional thoughts on that. Are you seeing where you really got to make sure the compliance is squared away? You got to make sure they, you know, written agreements are there. This is not just like running a a cash chiropractic practice What are your what are your takes on that?

Michael Silverman: Heck even if you are running a cash chiropractic practice I have to stress the importance of written agreements and compliance programs again Just to protect everything that you guys are working so hard You know, in your livelihoods and your your licenses in your business endeavors.

Um, let's let's talk about the importance of contracts, right? You always want to do your best to prevent. [00:19:00] He said, he said, he said, she said, she said, she said type of situation. Um, and you want to set forth expectations, duties, responsibilities, benefits, governing law, dispute resolution. Maybe you want things to be privately hashed out in the event of a dispute through a mediator or a binding arbitration, rather going than going through the, the, the, the headaches and, and, and time and, and cost of.

of litigation in the event of employment, um, disputes, but something that, um, that we were, we were chatting about recently, doc, is whether you're a standalone chiropractic practice or a medically integrated chiropractic practice is how rampant misclassification is, um, just in the healthcare industry generally.

And by misclassification, I mean, Is somebody that comes to work for you, should they be a W 2 employee or a 1099 independent contractor? And I have to let all the listeners out there know that it's not up to [00:20:00] you and it's not up to your worker, right? You know, as much as we may want to bring on somebody as an independent contractor, um, to try to, um, not bear the cost of, you know, Some of our FICA taxes and employment related taxes, if somebody is coming and working for you under your direction and your control, they're on your website, you're holding them out as a worker of your business, you're doing your scheduling in most cases, especially if they're working 10 plus hours a week, they're likely going to be a W2 employee and not a 1099 independent contractor.

And the consequences for misclassification, um, you know, you're dealing with, um, not only, uh, the IRS for taxes that could be, should have been withheld, Department of Labor, overtime expectations and payments, and usually every everyone's happy. Everything's honky dory until, you know, somebody's not happy or somebody gets terminated and said, hey, you know, it's a, it's an office [00:21:00] staff manager.

And I was working over 40 hours a week. I should have been paid time and a half. Yeah. So you really want to do that analysis. I wish I could say there was a bright line test or rule. That's, you know, you can say, here's the criteria and yes, or no, there's a lot of different criteria put out by various governing bodies, the Department of Labor, federal deal has a test.

The IRS and essentially, you know, you really got to match up to how much control you're exercising over this individual, whether they can do things on their own, on their own schedule, use their own equipment and then, and then classify them accordingly. And irrespective of how they're classified, you want to make sure you match that classification with a written agreement.

Dr. Kevin Christie: Yeah, and it's such a problem and I know you see it all the time in the chiropractic profession, I'm sure others, but you know, even just think about it, like how you explain the D. O. M. D. Um, medical director supervising physician like that's a legitimate I. C. scenario like they don't, they make their own schedule like, you know, it's just, that's [00:22:00] exactly what it is.

Whereas a lot of these chiropractors that are, um, um, You know, the other thing that's funny is you can even hear it in the language, the chiropractor is like, Oh yeah, I got an associate or a chiropractor that works for me. It was like, and there are 1099, like they don't work for you, even like in the way they verbalize it.

But if you don't mind, I'd like to just share, you had a great slide on here with some of the key things to look at for employee versus independent contractor. Can I just rattle that off real quick?

Michael Silverman: Yeah, please run through it.

Dr. Kevin Christie: Yeah, so the innovative contractor is basically running their own business, uh, paid upon completion of a project Provides own materials tools and equipment works with multiple clients Temporary relationship until project completed decides when and how they will perform the work decides what work they will do I mean obviously Doesn't necessarily all of those, but those are like the characteristics of a independent contractor.

That doesn't sound like many chiropractic associate, uh, job description. Now, an employee would be working for someone else's business paid hourly, salary or by. Piece rate uses [00:23:00] employees, materials, tools, and equipment typically works for one employer, continuing relationship with the employer, um, employee, sorry, employee, or decides when and how the work will be performed.

Employer assigns the work to be performed. I mean, it's pretty clear cut. And I know you mentioned the IRS test. Uh, this is a federal thing. This isn't a Florida thing. This is every state union. And, um, you know, when you're. Whether you're not medically integrated or you are going to integrate, you got to get clear on that.

And too many people are making a mistake. Like I almost feel like I want to make that my goal in life is to get every chiropractic practice to be doing that correctly because there's so many that aren't.

Michael Silverman: If we can share this link from the DOL on this beautiful chart that they put together, you know, when we put out the this recording, it'd be wonderful.

Very helpful again, because there's so much misinformation out there. And heck, even when I brought on an attorney, as much as I wanted to avoid paying those taxes and make him an [00:24:00] independent contractor, I took a step back and I said, You know, what would we be advising a client and me and my law partner, you know, it was, it was certainly obvious.

So protect, protect yourself to that. And, and again, um, you know, the, the contract accordingly that, you know, comes together, um, you know, is, is to tie everything into protect your business and in different states, you know, so your, your APRN that maybe comes on one hour a week, two hours a week, a couple hours a month.

Um, they may properly be classified at first as an independent contractor, but as their role evolves and their work within your organization evolves, you certainly want to make sure that you stay on top of those classification matters. And I was recently down in Miami at the National Association of Chiropractic Attorneys Conference and there were several lawyers from California that were out there and they informed there's a regulation in California that the, the amount of, of.

of work that they do on behalf of your practice aside, if what they're doing is an [00:25:00] essential element of your practice, like a chiropractic, a DC associate working for a chiropractic practice, there's no wiggle room. There's no 1099. It's legally has to be a W2. What California does often, you know, slowly but surely makes its way across the country.

So we'll really have to keep an eye on, on how those regulations change, but that's certainly my mission as well as yours, to help people classify correctly.

Dr. Kevin Christie: And so it's like, if you always reference, uh, California, Florida, Texas, New York, you start to get a kind of a swath of the whole country there, just obviously because of the size of the, of the state.

So, uh, we've, we've been a little bit Debbie Downer here. I didn't want to be that a whole time, but that's, uh, sometimes the nature of the beast. Let's hear some positive stuff. What are some examples of multidisciplinary practices that you're working and seeing and helping out with that are, that are thriving?

Michael Silverman: Yeah, let's um, let's turn the conversation around a little bit. We've given some of the the warning size kind of the do's and don'ts, but why would somebody want to even consider, you know, medically integrating their [00:26:00] practice? It's, it's, it's a, it's, it has so many benefits for you and your practice. First and foremost, um, talk about Oversight of your patient care, right?

How many times do we hear about situations where a loved one goes to a medical practice or a hospital, and there's no communication between their treating healthcare providers and there's no continuity of care. So first and foremost, it's, it's to make the best, Patient outcomes for your practice in your office.

They can receive all of the care that they may need. Um, secondarily, but, um, you know, certainly not not to forget is the increase in revenues to your practice. Right? Um, you know, certainly if. If you're struggling to sell chiropractic services, your theoretical apples, you shouldn't just add on another service category and think that's going to help your business out.

You should focus on selling your chiropractic services and filling, figuring out why you may have an issue there. But if you look and see that. For your [00:27:00] practice, let's say you have a, um, a personal injury, intense chiropractic practice, and you know that your patients are going to get joint injections and other types of pain relieving activities from another office, heck, it may make a whole bunch of sense to bring on that.

And NP or PA to provide those joint injections down here in South Florida, where, you know, sextel cells and everything is aesthetic. Um, there's, there's, I work with a tremendous amount of chiropractic medically integrated practices that serve as med spas, the IV nutraceuticals, the Botox, the aesthetic stuff, a lot of the cash based services.

So what may be good for your chiropractic practice may not be good for your neighbor's chiropractic practice as far as the services that you're going to look to add on. But certainly it is a way to oversee all your patient care, make sure they get the best outcomes and to increase your revenue. So done the right way.

If it's a good fit for you, it's certainly something. To look into and make sure you do [00:28:00] correctly. Oftentimes, folks come to me. I mentioned after the fact, they're in a relationship with a non licensed chiropractor or or a brother in law, we're attorneys, not magicians. We can't undo what's been done already.

We can certainly mitigate things. So the purpose of today for somebody that is looking to medically integrate is really just, uh, you know, as a look before you leap, be aware of some of the rules and regulations that apply and just make sure you dot your I's and cross your T's before you jump on in.

Dr. Kevin Christie: Yeah, I love it. And there's a, a big contingency of our audience are, uh, what we would call sports chiropractors. And, uh, you know, you could do a lot of cool things if you had that integration capability, even around sports medicine and you could, um, um, You know, really take your practice to the next level with it.

And that's an opportunity as well. It's, you know, there's a lot of undertaking. There's going to be associated costs, but you're going to want to do it right. You know, you're, you're probably going to want to save a fair amount of money [00:29:00] to be able to bring on the proper legal team to get it all squared away and done correctly to have a little bit of money put away to compensate the, the uh, MDDO for their work.

And obviously if you're going to be bringing on a nurse practitioner or physician's assistant, there's going to come with that. So you got, you got to prepare for it financially, uh, legally, uh, but even just conceptually with what your vision of your, of your ideal practice would be, which would be cool.

And so thank you for, uh, some of those examples of multiplied multidisciplinary practices. One question I did have, Um, let's say the, the chiropractor is in network with the insurances and they do this. Um, they, they bill it on, is it, they bill it under their health insurance, but under the say MDs, if it's an MD service, uh, they bill it under the MDs MPI, is that correct?

Michael Silverman: That's a that's a great question. And you said you would if you are contracted with insurance providers to provide some of these medical [00:30:00] services, you would essentially on board and get your either MD deals or your mid level practitioners credentialed underneath the practice through their MPI, so that you can build under your organization, but you mentioned a great point as far as insurance, no insurance.

Depending on the types of patients you want to service what you want to service them with and who the payers for those services are, there's going to be less or more regulatory red tape that has to be gone through, especially with, you know, cash based services, less regulatory red tape. Um, when you're billing Medicare or commercial insurances, especially as a chiropractic practice, you're going to want to really analyze your taxonomy and NPI type, whether you're organized as a straight standalone chiropractic practice, or whether you are can be modified to a multidisciplinary or medically integrated practice, because if you are a standalone NPI, Chiropractic practice [00:31:00] and have a taxonomy as such some of the commercial insurance payers may give you some pushback when you look to credential or do some of this billing.

So you certainly want to do that type of analysis. Sometimes it may necessitate opening up a new co a new entity or legal corporation and and slowly winding down your existing business and dumping it into the new organization and operating everything. Through that new organization, there's a lot, you know, there's there's stark regulations involved and kickback regulations.

So you want to make sure how you structure that is correctly. But certainly, you know, you want to look at your organizational setup. Somebody came to me recently in Florida through a. Um, a PLLC, a professional limited liability corporation and a company, excuse me, and they were rendering medically integrated services, but a PLLC in Florida, a professional liability company, it has to be owned by the type of medical professional that can legally oversee those services, [00:32:00] right?

So we had to modify them into a regular LLC because otherwise it'd have to be owned by an MD or DO. So little things like that, again, state laws and nuances that you'll want to check with.

Dr. Kevin Christie: Love it. And I recently had Brandy Brimhall on my show. She's an insurance credentialing specialist for any state and anything.

And she actually has a quite a skill set in in working through some of the details of the insurances, which I'm sure is outside of your your scope of dealing with some of that, right?

Michael Silverman: Oh, Doc, it takes it takes a village as you kind of alluded to, right? You got to mentally prepare yourself. You got to financially prepare yourself and you got to, you know, you got to engage the right legal team, the right accountants, the right credentialing folks, and the right business coaches for that matter, because, you know, myself, I'm, I can give you the rules and the laws, but I'm not a clinical expert, you know, you need some boots on the ground to help you develop those clinical policies, procedures and oversight, um, so that you can Really, you know, be best [00:33:00] set up for success there.

So you're exactly right.

Dr. Kevin Christie: Love it. Well, this has been great. Um, question, you know, obviously Florida, we have quite a few, uh, listeners that are from Florida. Is there any other states your firm is, is able to work with? Um, is there, uh, maybe there's particular, they can even reach out if there's a contact you have, what's the scoop on that?

Michael Silverman: Sure. So, um, my firm, we're, we're licensed in Florida and New York. Um, so we can provide state specific advice and regulations to that. And we work with healthcare business owners and chiropractors. I mentioned on a nationwide basis as it pertains to Medicare regulations, working to enroll them in Medicare B for durable medical equipment, for example.

Well, we also do a lot of transactional stuff, helping, um, Cairo's buy and sell their practices across the country. So we can certainly help there. And as I mentioned, I'm a, I'm one of the attorneys that's a member of the national association of chiropractic attorneys. So if it's something that my office can't help out with, certainly, uh, we can help point you in the right [00:34:00] direction.

We'd be happy to do so.

Dr. Kevin Christie: Yeah, and that's the thing that I love about your firm and why I wanted you on is that there's a distinct expertise within the chiropractic profession, just not a law firm that happens to work with a handful of chiropractors. You guys have really, really got a great niche within our profession and understand all of the nuances of it and speak the language.

So how could they reach out to you?

Michael Silverman: Um, you can. Can go to my website, SilvermanBain. com, S I L V E R M A N B A I N, you can schedule a free consultation with any of the attorneys there. Also has our contact information for our office in my email. Um, again, it's, uh, www. SilvermanBain. com. You know, I couldn't become a chiropractor myself.

As I mentioned, my father still practices locally and has a medically integrated practice. So, you know, it's something that, um, you know, I, you know, even if it's not a client, I enjoy talking about discussing, there's a lot of misinformation out there and to try to help people build practices and practices [00:35:00] successfully.

So always happy to chat about the industry to help anyone that we can.

Dr. Kevin Christie: Well, this has been great. Michael, I really appreciate your, your time today and we'll have to do a part two.

Michael Silverman: Absolutely. I, uh, doc sincerely appreciate your having me on and I wish everybody a wonderful holiday season and a killer start to 2025.

And if you're looking to medically integrate again today, some food for thought as far as how you can compliantly expand your business, take care of patients and increase your revenues.