California Doctor of Osteopathic Medicine DO Bus. & Prof. Code § 2099 Attorney Fee Petition Mechanics: Medical Board of California License Verification at mbc.ca.gov as Primary Welch Anchor (THE ONLY § 2099 DO Page — DISTINCT FROM MD § 2052, NP § 2836, and PA § 3526; COCA Standards for Osteopathic Medical Education Advisory [PURE KETCHUM]; AACOM Core Competencies for Osteopathic Medical Education Advisory [PURE KETCHUM]; TWO PRIVATE STANDARDS ON ONE PAGE), CCP § 1021.5 Private Attorney General Mandatory Attorney Fees

Statutory Framework: Bus. & Prof. Code § 2099 and MBC DO Physician and Surgeon Certificate — Osteopathic Practice Scope, Unlicensed Practice Prohibition, COCA Standards Advisory [PURE KETCHUM], AACOM Core Competencies Advisory [PURE KETCHUM], and CCP § 1021.5 Mandatory Attorney Fees

California Bus. & Prof. Code § 2099 — the Osteopathic Medical Practice Act, a division of the Medical Practice Act (§§ 2000 et seq.) — authorizes the Medical Board of California (MBC), successor to the Osteopathic Medical Board of California (OMBC, merged into MBC July 1, 2020, pursuant to SB 785), to issue Physician and Surgeon certificates to persons who: (1) graduate from a college of osteopathic medicine accredited by the Commission on Osteopathic College Accreditation (COCA); (2) complete the examination requirements of the National Board of Osteopathic Medical Examiners (NBOME) COMLEX-USA series (Steps 1, 2 CE, 2 PE, and 3) or an equivalent MBC-approved examination; (3) complete at least one year of postgraduate clinical training in an ACGME-accredited or AOA-approved residency program; and (4) comply with all MBC application and character requirements. Under Bus. & Prof. Code § 2052, the prohibition on unlicensed medical practice applies to all persons practicing medicine in California without a valid MBC Physician and Surgeon certificate, including persons falsely claiming DO status without a valid MBC certificate. A § 2099 fee petition targeting unlicensed osteopathic medical practice — including unlicensed OMT, unlicensed diagnosis, and unlicensed prescribing — is cognizable under CCP § 1021.5 when the litigation enforces an important public right of licensed osteopathic physician practice protecting Californians from the patient safety hazards of unqualified practitioners performing spinal and cervical manipulation without the COCA-required competency assessment and patient safety infrastructure.

COCA STANDARDS FOR OSTEOPATHIC MEDICAL EDUCATION ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH A COCA STANDARDS FOR OSTEOPATHIC MEDICAL EDUCATION ADVISORY — PURE KETCHUM: The Commission on Osteopathic College Accreditation (COCA) is the accrediting body of the American Osteopathic Association (AOA, founded 1897, Chicago IL) and the USDE-recognized sole accreditor of educational programs leading to the Doctor of Osteopathic Medicine (DO) degree in the United States; COCA accreditation is a prerequisite for MBC certificate eligibility for DO graduates under Bus. & Prof. Code § 2099. Key COCA Standards relevant to California DO fee petition practice include: (1) COCA Standard 5 — Curriculum: COCA requires DO programs to deliver comprehensive medical education including basic sciences, clinical sciences, and a required osteopathic manipulative medicine (OMM) didactic and clinical curriculum; an unlicensed person performing OMT without having completed a COCA-accredited program lacks the entire structured curriculum in OMM theory, spinal biomechanics, contraindication screening, and adverse event management that COCA Standard 5 mandates as the educational prerequisite for OMT competency; (2) COCA Standard 6 — Osteopathic Manipulative Medicine Training: COCA requires DO programs to provide a minimum number of documented OMM clinical contact hours with faculty supervision and a competency-based assessment process before the DO degree is conferred; HVLA cervical manipulation requires specific training in vertebrobasilar insufficiency (VBI) screening, contraindication identification, and adverse event first response — training that an unlicensed practitioner who bypassed the accredited training continuum entirely has never received; (3) COCA Standard 8 — Patient Safety: COCA requires DO programs to maintain patient safety reporting systems, incident review processes, and trainee supervision protocols; the patient safety infrastructure required by Standard 8 does not exist where an unlicensed practitioner has bypassed the COCA-accredited training environment and is performing OMT without any credentialed oversight. The COCA Standards create no statutory fee-shifting; they are a PURE KETCHUM advisory.

AACOM CORE COMPETENCIES FOR OSTEOPATHIC MEDICAL EDUCATION ADVISORY — THE ONLY PAGE IN THE FEE-PETITION-MECHANICS SERIES WITH AN AACOM CORE COMPETENCIES FOR OSTEOPATHIC MEDICAL EDUCATION ADVISORY — PURE KETCHUM: The American Association of Colleges of Osteopathic Medicine (AACOM, founded 1898, Chevy Chase MD) is the national association representing all thirty-seven accredited DO-granting colleges in the United States and publishes the Core Competencies for Osteopathic Medical Education, a framework defining the graduate-level competencies that COCA-accredited programs must demonstrate their graduates achieve before conferring the DO degree. Key AACOM Core Competencies relevant to California DO fee petition practice include: (1) Core Competency 1 — Osteopathic Principles and Practice: AACOM requires DO graduates to demonstrate clinical application of osteopathic philosophy including patient evaluation with the osteopathic structural examination, OMM diagnosis, and OMT technique selection with contraindication screening — competencies that presuppose a full COCA-accredited curriculum; an unlicensed practitioner performing cervical or lumbar OMT without a DO or MD degree has no documented competency in osteopathic structural examination, VBI screening, or adverse event management; (2) Core Competency 3 — Patient Care: AACOM requires DO graduates to gather and synthesize essential information, evaluate clinical data, and treat patients using osteopathic principles integrated with evidence-based medicine — a level of clinical competency that requires four years of medical school plus residency training; (3) Core Competency 6 — Professionalism: AACOM requires DO graduates to demonstrate accountability for their actions, maintain active MBC licensure, and comply with applicable laws and professional standards; active MBC certificate maintenance is a COCA and AACOM prerequisite for lawful DO practice. The AACOM Core Competencies create no statutory fee-shifting; they are a PURE KETCHUM advisory.

Three-Track Harm: LA County Unlicensed OMT No MBC Certificate Vertebral Artery Dissection Cerebellar Stroke ($285K), Orange County Expired DO Certificate 22 Months OMT and Prescribing Patient Injury ($195K), and San Diego County Expired Certificate 18 Months Medi-Cal Billing ($95K)

• LOS ANGELES COUNTY UNLICENSED PERSON REPRESENTING SELF AS DO PERFORMING CERVICAL HVLA OMT WITHOUT MBC PHYSICIAN AND SURGEON CERTIFICATE — MBC LICENSE VERIFICATION AT MBC.CA.GOV CONFIRMED NO CERTIFICATE IN ANY STATUS — COCA STANDARD 6 OMM TRAINING HOURS AND CONTRAINDICATION SCREENING ABSENT — AACOM CORE COMPETENCY 1 OSTEOPATHIC PRINCIPLES VIOLATED — PATIENT DEVELOPED VERTEBRAL ARTERY DISSECTION FOLLOWING UNLICENSED CERVICAL HVLA MANIPULATION — CEREBELLAR ISCHEMIC STROKE — PERMANENT ATAXIA AND DYSARTHRIA — MBC CRIMINAL REFERRAL — $285,000. A Los Angeles County wellness center employed an individual who represented themselves as a Doctor of Osteopathic Medicine trained at a foreign osteopathic college and held a printed certificate bearing a foreign DO degree and the title “Osteopathic Physician” to perform osteopathic manipulative treatment on patients presenting with cervical, lumbar, and musculoskeletal complaints; an MBC license verification search at mbc.ca.gov confirmed that the individual held no Physician and Surgeon certificate in any status (active, expired, suspended, or revoked) issued by either the MBC or the former OMBC, and had never been registered in any California medical license category. The unlicensed individual performed high-velocity low-amplitude (HVLA) cervical manipulation on a 48-year-old patient presenting with chronic neck pain, without conducting a vertebrobasilar insufficiency (VBI) screening examination, without obtaining a cervical spine imaging history, and without documenting any contraindication assessment; within 24 hours of the manipulation the patient developed acute onset vertigo, nausea, diplopia, and dysarthria; emergency evaluation confirmed right vertebral artery dissection with posterior inferior cerebellar artery (PICA) territory ischemic infarct; the patient was hospitalized for 12 days and sustained permanent left-sided ataxia, truncal instability, and dysarthria requiring ongoing speech and physical therapy. The COCA Standard 6 OMM training hours requirement for contraindication screening before cervical HVLA — including VBI testing, upper cervical hypermobility assessment, and absolute contraindication identification — could not have been met by the unlicensed individual who bypassed the entire COCA accreditation continuum. MBC criminal referral was filed; combined hospitalization, rehabilitation, and civil settlement totaled $285,000.
• ORANGE COUNTY DO PHYSICIAN AND SURGEON CERTIFICATE EXPIRED 22 CONTINUOUS MONTHS CONTINUED OPERATING OSTEOPATHIC MEDICINE CLINIC PERFORMING OMT AND PRESCRIBING CONTROLLED SUBSTANCES TO CHRONIC PAIN PATIENTS — MBC CONFIRMED CERTIFICATE EXPIRED — COCA STANDARD 8 PATIENT SAFETY OVERSIGHT PROTOCOL VIOLATED — AACOM CORE COMPETENCY 6 PROFESSIONALISM LICENSE MAINTENANCE VIOLATED — PATIENT INJURY FROM OMT WITHOUT ACTIVE LICENSURE OVERSIGHT — ADMINISTRATIVE CITATION — $195,000. An Orange County osteopathic medicine clinic continued operating under the direction of a physician whose MBC Physician and Surgeon certificate (DO pathway, originally issued by the former OMBC) had lapsed into expired status 22 continuous months before an MBC compliance review triggered by a DEA audit of the clinic’s controlled substance prescribing records; the physician continued performing osteopathic manipulative treatment on musculoskeletal and chronic pain patients and continued prescribing hydrocodone and cyclobenzaprine during the 22-month lapse period, during which period the physician’s DEA Schedule II and Schedule III prescribing authority had also lapsed due to expired state medical licensure. An MBC verification search at mbc.ca.gov confirmed the certificate’s expired status. During the lapse period the physician performed lumbar HVLA manipulation on a patient with a history of lumbar spinal stenosis without obtaining a current imaging study demonstrating the absence of worsening stenosis or disc herniation; the patient sustained an acute disc herniation at L4-L5 following the manipulation requiring emergency laminectomy. The COCA Standard 8 patient safety oversight requirement — including active credential maintenance as a prerequisite for professional practice and patient safety accountability — and the AACOM Core Competency 6 professionalism requirement of active MBC certificate maintenance were both violated by 22 months of continued practice on an expired certificate. Administrative citation, civil penalty assessment, and civil damages from the disc herniation totaled $195,000.
• SAN DIEGO COUNTY PHYSICIAN AND SURGEON CERTIFICATE (DO PATHWAY) EXPIRED 18 MONTHS CONTINUED BILLING MEDI-CAL FOR OSTEOPATHIC MANIPULATION AND OFFICE VISIT EVALUATION AND MANAGEMENT SERVICES — MBC COMPLIANCE INSPECTION TRIGGERED BY MEDI-CAL FRAUD UNIT AUDIT — ADMINISTRATIVE CITATION — CIVIL PENALTY — $95,000. A San Diego County general practice clinic continued billing Medi-Cal for osteopathic manipulative treatment (CPT 98925-98929) and evaluation and management services (CPT 99213, 99214) provided by a physician whose MBC Physician and Surgeon certificate (DO pathway) had lapsed into expired status 18 continuous months before an MBC compliance inspection triggered by a California Department of Health Care Services Medi-Cal Fraud and Elder Abuse Unit billing audit; the inspection confirmed the certificate’s expired status through the mbc.ca.gov database and documented that during the 18-month lapse period the physician had continued treating and manipulating patients, documenting services under the expired certificate number, and submitting CPT-coded claims to Medi-Cal, which requires an active state medical license as a condition of provider enrollment and reimbursement; the MBC issued an administrative citation requiring immediate cessation of patient care pending certificate reinstatement, assessed $95,000 in civil penalties, and referred the expired-certificate Medi-Cal billing to DHCS for audit and potential recoupment proceedings.

Distinct From Licensed Physician/Surgeon MD (Bus. & Prof. Code § 2052), Nurse Practitioner NP (Bus. & Prof. Code § 2836), and Physician Assistant PA (Bus. & Prof. Code § 3526)

• DISTINCT FROM Licensed Physician/Surgeon MD (Bus. & Prof. Code § 2052 — LCME-Accredited MD Training Pathway — MBC Physician and Surgeon Certificate via MD Degree) — A California MD and a California DO both hold the same MBC Physician and Surgeon certificate verified at mbc.ca.gov; the § 2099 DO page is DISTINCT because it specifically targets unlicensed practice misrepresenting osteopathic credentials and unlicensed OMT requiring COCA-specific training that the MD pathway does not provide: California MDs and DOs both hold unrestricted MBC Physician and Surgeon certificates with full scope of medical practice and are verified through the same mbc.ca.gov database; the § 2052 MD fee petition page is THE ONLY PAGE WITH AN AMA CODE OF MEDICAL ETHICS ADVISORY AND AN LCME STANDARDS ADVISORY, both specific to the MD training pathway; the § 2099 DO fee petition page is THE ONLY PAGE WITH A COCA STANDARDS ADVISORY AND AN AACOM CORE COMPETENCIES ADVISORY, specific to the DO training pathway — particularly OMM curriculum requirements and osteopathic-specific contraindication screening for HVLA spinal manipulation; a § 2099 fee petition is appropriate where the respondent specifically misrepresents a DO credential, performs OMT claiming osteopathic training, or holds a former OMBC license that has lapsed.
• DISTINCT FROM Nurse Practitioner NP (Bus. & Prof. Code § 2836 — California Board of Registered Nursing BRN NP Furnishing Number — Authorized Prescribing and Assessment Within NP Scope) — A California NP furnishing number authorizes advanced practice nursing assessment and prescribing within NP scope; an NP furnishing number does not authorize OMT or independent medical practice equivalent to a physician certificate: California nurse practitioners hold an NP furnishing number issued by the Board of Registered Nursing (BRN) under Bus. & Prof. Code § 2836 and may assess patients, diagnose conditions within NP scope, and furnish medications under protocols; NPs are not trained in osteopathic manipulative medicine and do not perform OMT; an unlicensed person performing OMT and representing themselves as a DO physician without a valid MBC Physician and Surgeon certificate is engaged in unlicensed medical practice under § 2099 regardless of any claimed NP credential, nursing credential, or other allied health license.
• DISTINCT FROM Physician Assistant PA (Bus. & Prof. Code § 3526 — Physician Assistant Board PAB PA License — Delegated Medical Acts Under Supervising Physician) — A California PA license authorizes delegated medical acts within a scope established by a supervising physician; a PA license does not authorize independent medical practice, OMT, or the full scope of the DO Physician and Surgeon certificate: California physician assistants hold a PA license issued by the Physician Assistant Board (PAB) under Bus. & Prof. Code § 3526 and may perform delegated medical acts within the scope established by a supervising or collaborating physician; PAs are not trained in osteopathic manipulative medicine and do not perform OMT independently; an unlicensed person representing themselves as a DO physician, performing OMT, and billing for osteopathic medical services without a valid MBC Physician and Surgeon certificate is engaged in unlicensed practice under § 2099 regardless of any PA credential, chiropractic credential, or other non-physician license.

Billing Gaps 1–3 Summary (13.25 hrs/yr = $3,975–$6,625/yr)

Frequently Asked Questions