Who the TBCE Regulates
Section summaryThe Board licenses chiropractors and oversees facility registration. Each licensee category has distinct disciplinary exposures, and facility ownership adds an additional layer of regulatory responsibility.
The Texas Board of Chiropractic Examiners has jurisdiction over chiropractors licensed under Occupations Code Chapter 201, including those holding the doctor of chiropractic degree and meeting Board examination and continuing-education requirements. The Board also has oversight responsibilities for chiropractic facility registration and for individuals practicing under chiropractic licensure in ancillary roles.
A complaint against an individual chiropractor may also implicate the facility where the practice occurs. Facility owners must understand that their facility registration carries independent regulatory exposure when individual licensees within the facility face allegations. Owners who delegate clinical work to associate chiropractors retain a degree of oversight responsibility that the Board may examine in a complaint.
Texas chiropractors hold a defined scope of practice that has been the subject of significant litigation over the decades. Understanding the current statutory scope is the starting point for any complaint that touches on scope questions. The boundary with physical therapy on one side and with medical practice on the other has been the focus of repeated regulatory and litigation activity, and the current statute and rules reflect a series of compromises that limit chiropractic scope in ways that practitioners must understand.
Common Disciplinary Grounds
Section summaryComplaints cluster around scope of practice, informed consent, advertising, billing, and patient interaction. Each category has distinct documentary and defensive considerations.
The Board's disciplinary grounds in Occupations Code Chapter 201 are broad and include unprofessional conduct, dishonest or fraudulent conduct, scope-of-practice violations, advertising violations, and conduct that endangers patients. The most frequent complaint categories include:
- Scope of practice. Allegations that the chiropractor performed acts outside the statutory scope or held out as something other than a chiropractor.
- Informed consent. Allegations that the patient did not receive adequate disclosure of the nature, risks, and alternatives of chiropractic adjustment, particularly cervical adjustments.
- Advertising. False, misleading, or deceptive advertising, including claims about training, scope, or outcomes; use of "specialist" terminology in ways the Board has restricted.
- Billing. Improper coding, balance billing, or billing for services not rendered, including Medicare and Medicaid coding issues.
- Sexual misconduct. Allegations of inappropriate touching, comments, or boundary violations during patient interactions.
- Substance abuse. Allegations of impairment or DUI convictions affecting fitness to practice.
- Criminal convictions. Convictions touching on fitness to practice or honesty.
- Practice with unlicensed persons. Improper use of unlicensed personnel for tasks requiring chiropractic licensure.
Scope of Practice Disputes
Section summaryScope-of-practice complaints are technically and historically complex in Texas chiropractic regulation. The boundary with PT and medical practice has been litigated repeatedly.
Scope-of-practice disputes have been a recurrent feature of Texas chiropractic regulation. The statutory scope and Board rules have been amended over time in response to litigation by medical and physical therapy associations, court decisions, and legislative changes. Practitioners facing scope-related complaints must work from the current statute and rules, not from historical understandings of permitted practice.
Common scope issues include:
- Boundary with physical therapy
- Allegations that the chiropractor performed services more properly characterized as physical therapy without proper credentialing or supervision arrangements.
- Boundary with medical practice
- Allegations of diagnosis or treatment beyond chiropractic scope, including representations about systemic conditions or use of modalities reserved to medical practice.
- Use of titles and credentials
- Allegations that the chiropractor held out as a specialist or used credentials not recognized by the Board.
- Imaging and diagnostic procedures
- Allegations that the chiropractor performed or interpreted imaging beyond the chiropractic scope.
Scope complaints often require expert review on both sides and may involve historical statutory and rule interpretation. A licensee facing a scope complaint should have counsel familiar with the regulatory history and the current statutory framework.
Billing and Documentation
Section summaryBilling complaints often originate from payors and may run in parallel with federal or state fraud investigations. Documentation is the central defense.
Billing complaints arrive at the Board from several sources: patients, payors, federal Medicare contractors, the Texas Office of the Inspector General for Medicaid, and other licensees. Common billing allegations include:
- Upcoding or billing for services more extensive than those rendered.
- Billing for services not documented or not actually performed.
- Improper coding of evaluation and management codes versus chiropractic adjustment codes.
- Balance billing patients in violation of network agreements.
- Improper relationships with referral sources implicating anti-kickback principles.
A billing complaint may run in parallel with a federal Medicare investigation, a Texas Medicaid OIG investigation, or a payor civil action. Statements made in the Board response can be used in those parallel proceedings. Counsel should coordinate the regulatory response with any criminal or civil defense to preserve appropriate protections.
The defense in billing cases typically turns on documentation: SOAP notes, treatment plans, time records, and the correlation between the records and the codes billed. Documentation gaps that may seem minor in isolation can support a broader allegation when patterns emerge across patient charts.
Investigation and ISC
Section summaryThe Board investigates, requests a written response, and may convene an informal settlement conference before referring matters to SOAH.
The TBCE process tracks the standard Texas licensing board sequence. After intake, the Board screens the complaint, and if it states a violation within the Board's jurisdiction, opens an investigation. The licensee receives notice of the complaint and a request for written response.
The written response should address the specific allegations with documentary support. A scope-of-practice response should attach the relevant SOAP notes and demonstrate alignment with the statutory scope. A billing response should attach the documentation supporting each coded service. An informed-consent response should attach the signed consent forms and demonstrate the disclosure provided.
If the investigation does not result in dismissal, the Board may convene an informal settlement conference. The ISC operates similarly to other Texas board ISCs: a small panel meets with the licensee, counsel, and Board prosecutor to discuss the allegations and explore resolution. Outcomes include dismissal, remedial conditions, agreed order, or referral to SOAH for formal contested case proceedings.
SOAH practice for the TBCE follows the standard contested case framework under the Texas Administrative Procedure Act and SOAH procedural rules.
Sanctions and Reciprocal Effects
Section summarySanctions range from administrative penalty through revocation. Reciprocal-discipline exposure in other states is a meaningful collateral consequence.
Occupations Code Chapter 201 authorizes a standard range of sanctions: administrative penalty, reprimand, probation with conditions, suspension, and revocation. Agreed orders may also include continuing education requirements, practice monitoring, supervision, or scope restriction.
Collateral consequences for a Texas chiropractor include:
- Reciprocal-discipline exposure in other states where the chiropractor holds licensure.
- Payor network re-credentialing reviews and possible network termination.
- Malpractice insurance underwriting consequences and possible premium increases.
- For Medicare billing matters, possible OIG exclusion under federal law.
- Reputational impact within the chiropractic community and the local patient base.
Each agreed order should be evaluated against this collateral consequences map before acceptance. A short suspension that triggers reciprocal action in three other states may be a worse outcome than a longer probation that does not.
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Call (972) 370-5060 →Investigation Procedure
Texas Chiropractic Board Discipline matters begin with a written complaint that the board's staff investigates. The licensee typically receives a notice of investigation that summarizes the allegation in general terms. The licensee has a finite window — often 20 to 30 days — to respond. For a TBCE matter, the response is the first strategic decision in the case and shapes the rest of the proceeding.
Counsel handling a TBCE matter should evaluate the strength of the underlying complaint, the agency's likely evidence, and the licensee's exposure across multiple sanction levels. The response can be comprehensive (admitting agreed facts, reserving contested issues, framing the licensee's narrative) or minimal (denying allegations broadly, reserving all issues for formal proceedings). Each approach has strategic advantages and costs.
The response should be coordinated with any parallel criminal case. Statements made to the board can become evidence in the criminal forum. Where the criminal case is active, the administrative response may need to be limited or to invoke the Fifth Amendment. The board can draw adverse inferences from privilege invocation in administrative proceedings; counsel must weigh whether the inference cost exceeds the criminal-exposure cost.
Sanction Continuum
Texas Chiropractic Board Discipline matters resolve across a sanction continuum from informal letter (the lightest, often non-public), through advisory letter, formal reprimand, fines, conditions on practice, suspension, and revocation. The right strategic target depends on the strength of the State's evidence, the licensee's history, and the agency's internal calibration.
For a TBCE matter, counsel should map the likely sanction range early and negotiate toward the best feasible outcome. Where the evidence is strong and a public sanction is unavoidable, counsel should focus on minimizing the sanction's severity and on shaping the public-record language. Where the evidence is contestable, counsel should consider whether contesting through SOAH produces a better expected outcome than accepting an Agreed Order.
The public-record consequences of any formal sanction are significant. Most Texas boards maintain searchable disciplinary databases that anyone can access. The record persists for the duration of the license and often beyond. Counsel should always discuss the public-record dimension with the client before recommending any disposition.
The Texas Board of Chiropractic Examiners framework
The Texas Board of Chiropractic Examiners operates under Texas Occupations Code Chapter 201 and Board Rules at 22 Texas Administrative Code Chapter 75. The Board regulates the practice of chiropractic in Texas including the licensure and discipline of chiropractors. The framework includes comprehensive disciplinary authority covering both clinical practice and broader professional conduct.
The disciplinary grounds under Chapter 201 include unprofessional conduct, departures from the chiropractic standard of care, conviction of specific offenses, fraudulent billing, and various other specific categories. The grounds provide substantial scope for Board enforcement action across the diverse chiropractic practice contexts. The defense must address both the specific grounds and the broader chiropractic regulatory context.
The Board investigation framework operates through Board staff and contracted investigators. The investigations include review of patient records, interviews with patients and chiropractic staff, examination of practice facilities and equipment, and consultation with chiropractic experts. The respondent chiropractor has rights to notice and to participate in the investigation through counsel.
The chiropractic scope of practice and the technique framework
The chiropractic scope of practice in Texas includes various specific procedures and techniques authorized under the Chiropractic Act. The scope has been the subject of substantial litigation and regulatory development over time, with specific issues addressed through court decisions and Board rulemaking. The current scope reflects this development and provides the framework for evaluating practice conduct.
The technique framework addresses the specific chiropractic procedures that are within the authorized scope. Procedures including spinal manipulation, related joint manipulation, certain rehabilitation techniques, and various other techniques are typically within the scope. Procedures that approach or exceed the scope boundaries can produce regulatory concerns and disciplinary investigation.
The defense in scope of practice cases requires expert engagement with practicing chiropractors who can address the appropriate scope and the application of the chiropractic standard. The expert testimony can support defense theories about the legitimacy of specific practices. The defense should also consider whether broader professional organization guidance supports the specific practices.
The billing and insurance framework in chiropractic practice
The billing and insurance framework in chiropractic practice involves substantial regulatory considerations including Medicare billing rules, private insurance contract requirements, workers compensation insurance rules, and various other specific frameworks. Failures in billing compliance can produce both regulatory disciplinary action and parallel criminal or civil exposure.
The fraudulent billing cases reach conduct involving false billing, billing for services not provided, upcoding to higher service levels, and various other forms of billing misconduct. The cases can produce Board discipline, parallel federal healthcare fraud prosecution, and civil False Claims Act litigation. The defense in fraudulent billing cases must coordinate responses across the multiple potential proceedings.
The defense framework in billing cases includes both substantive defenses to the specific billing allegations and various procedural defenses. The defense should examine the specific billing transactions, the applicable billing rules, the documentation supporting the billings, and various other elements. The defense should also consider whether expert testimony on chiropractic billing practices can support the defense theories.
Disposition framework and the practice management considerations
The disposition framework in chiropractic discipline cases includes various negotiated outcomes and contested litigation. The negotiated outcomes can include continuing education requirements, practice restrictions, billing audits and corrections, license suspensions, and various other structured responses. The disposition options should be evaluated against the realistic litigation outcomes and the practice management implications.
The practice management implications of chiropractic discipline include effects on the chiropractor ability to continue patient care, the financial implications of any restitution or penalty obligations, the insurance billing implications, and various other practice considerations. The defense should address these comprehensive implications when evaluating disposition options.
The professional liability insurance implications can be substantial. Disciplinary findings can affect insurance availability, premiums, and coverage provisions. Some insurance carriers may decline to cover chiropractors with active disciplinary issues. The defense should consider the insurance implications and should help chiropractors plan for the practical consequences of various potential dispositions on their professional liability protection.
Frequently Asked Questions
Can the TBCE discipline me for a billing dispute with a private insurer?
How does the Board handle scope-of-practice complaints?
Will I be barred from practicing during a Board investigation?
Does a TBCE sanction follow me to other states?
Can I avoid Board action by surrendering my license?
Read the full Texas Professional License Defense Guide
This article is one section of our comprehensive Texas Professional License Defense Guide. The pillar guide covers recent developments, official resources, and the complete framework with deeper analysis.
Read the Pillar Guide →Next Steps
If you are facing a situation described here, consult counsel promptly. Many issues in this area run on strict deadlines.
- Call (972) 370-5060
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Cite this guide
Bluebook: Reggie London & Njeri London, Texas Chiropractic Board Discipline, L&L Law Group (May 30, 2026), https://landllawgroup.com/insights/texas-chiropractic-board-discipline/.
APA: London, R., & London, N. (2026, May 30). Texas Chiropractic Board Discipline. L&L Law Group.