Outpatient physical therapy, chiropractic, and rehabilitation clinics in medical office buildings, strip centers, and professional plazas. These tenants require specialized buildout including treatment rooms, therapy pools, and equipment areas that create specific CAM and utility exposure. Annual CAM exposure for this tenant type ranges up to $8,000-$30,000. CAMAudit runs 14 forensic detection rules specific to your lease structure in under fifteen minutes.
A CAM audit for physical therapy and chiropractic clinics reviews NNN lease reconciliations to identify water and utility allocation errors related to therapy pool operations, capital improvement costs (ADA compliance, elevator modernization) billed as operating expenses, and after-hours HVAC charges on clinics with extended appointment schedules.
TL;DR
Physical therapy and chiropractic clinics overpay $2,500 to $8,000 per year from water allocation errors on therapy pools and capital improvement costs billed as operating expenses.
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Most therapy clinic tenants recover $2,500 to $8,000. Results in under 15 minutes.
Free CAM audit → Find My OverchargesTypical Lease Structure
Triple Net (NNN) or Modified Gross in medical office buildings
Avg. Locations
1-50+
Annual CAM Exposure
$8,000-$30,000
Triple Net (NNN) or Modified Gross in medical office buildings, tenant pays base rent plus a pro-rata share of property taxes, insurance, and CAM. Medical-adjacent leases often include specific provisions for water usage (therapy pools) and after-hours access.
Physical therapy clinics with hydrotherapy or therapy pools consume significantly more water than standard office tenants. When water costs are allocated pro-rata by square footage, the clinic pays a share proportional to its space rather than its consumption. Depending on pool size and usage, the actual water consumption may be 3 to 5 times higher than the pro-rata allocation would suggest, creating a distortion in either direction depending on the clinic's GLA share.
Medical office buildings undergo periodic capital improvements including elevator modernization, ADA compliance upgrades, lobby renovations, and building system replacements. These projects have useful lives of 15 to 30 years. When billed as single-year operating expenses, tenants absorb the full capital cost rather than an amortized annual fraction.
Clinics with early morning (6 AM) or evening (7 PM+) appointment schedules may incur after-hours HVAC and building access charges if their operating hours extend beyond the standard building schedule. These charges should be reviewed against the lease's HVAC and access provisions to determine whether extended hours were negotiated as part of the base lease terms.
Water and sewer allocated pro-rata despite therapy pool
Therapy pool operations consume water at rates far exceeding standard office usage. Pro-rata allocation by square footage does not reflect actual consumption patterns. If the lease specifies metered allocation or sub-metering is available, usage-based billing is required.
Detection: Request water utility bills and sub-meter readings if available. Compare the allocation method on your reconciliation to your lease terms. If sub-meters exist but are not being used for allocation, the billing methodology may be non-compliant.
Elevator modernization billed as operating expense
Elevator replacement and modernization projects cost $75,000 to $200,000+ per elevator and have useful lives of 20 to 30 years. Billing the full cost as a single-year operating expense forces tenants to absorb a multi-decade capital cost in one year.
Detection: Review the reconciliation for elevator-related line items. Request the project scope, total cost, and completion date. If the project involved equipment replacement or system modernization, it is a capital improvement that must be amortized.
ADA compliance upgrades in operating CAM
ADA compliance projects improve the building's long-term accessibility and value. These are capital improvements by definition: they create a new building capability that did not previously exist. Including them in operating CAM treats a permanent improvement as an annual expense.
Detection: Flag any line item referencing ADA, accessibility, or compliance upgrades. Request the project scope and verify whether it created new building features (capital) versus maintained existing ones (operating).
After-hours HVAC on extended clinic hours
If your lease negotiated specific HVAC operating hours as part of the base terms (e.g., 6 AM to 8 PM for a clinic with early and late appointments), charges for HVAC during those negotiated hours are already covered. Additional after-hours charges within your lease-specified window are overbilling.
Detection: Review your lease for HVAC schedule provisions. Compare the standard building schedule to your negotiated hours. If charges appear for time within your negotiated window, they are unauthorized.
Medical waste disposal costs spread to non-medical tenants
Medical waste disposal is a direct expense of the generating tenant, not a shared CAM cost. If the landlord classifies medical or biohazard waste pickup as shared CAM, non-medical tenants subsidize costs they do not generate.
Detection: Review the CAM ledger for medical waste, biohazard disposal, or sharps container line items. Request the waste hauler contract to determine which tenants the service covers. If it serves only medical tenants, it should be a direct charge.
74%
74% of medical office building tenants find at least one CAM billing error when they audit their reconciliation, per BOMA 2024 Office Experience Exchange Report on medical office expense management [industry estimate].
Via: BOMA International [industry estimate] (2022)
Watch For This Trigger
Landlord completes an elevator modernization or ADA compliance project and bills the entire cost to tenants as a single-year operating expense rather than amortizing over the improvement's useful life.
Most therapy clinic tenants recover $2,500 to $8,000. Results in under 15 minutes.
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Find My OverchargesNovaCare Rehabilitation v. Medical Center Associates
No. 2:11-cv-03456 (E.D. Pa. 2012)
Physical therapy tenant challenged elevator modernization costs billed as single-year operating expenses. Court ruled that elevator replacement constitutes a capital improvement amortizable over its useful life, not a single-year CAM charge.
Annual CAM Bill
$30,000/year
Typical Recovery
$2,500-$8,000
ROI Multiple
12-40x
Upload your lease. CAMAudit runs 14 detection rules in under 15 minutes.
When a CAM Audit May Not Apply
About the Author
Angel Campa is the founder of CAMAudit and a Principal SDET. He built CAMAudit after discovering that commercial tenants routinely overpay CAM charges due to errors that go undetected without forensic analysis. Connect on LinkedIn
Need to extract lease terms before your audit?
A CAM audit is only as accurate as your lease data. lextract.io extracts 126 structured fields from any commercial lease PDF: CAM definitions, pro-rata share, caps, base year, and audit rights. So you have the exact terms your landlord is supposed to follow.
Go to lextract.ioThis page provides general educational information. It is not legal advice and may not reflect the most current law in your state. Consult a licensed attorney for advice specific to your situation.
