YOUR OFFICE RECEIVES AN OVERPAYMENT FOR A SERVICE RENDERED TO A MEDICARE OR MEDICAID PATIENT. PERHAPS THIS WAS SIMPLY AN ERROR ON THE PART OF THE PAYING ENTITY OR PERHAPS IT WAS THE RESULT OF AN IMPROPER SUBMISSION ON YOUR PART. WHATEVER THE REASON YOU ARE NOW IN THE THICKET OF WHAT MAY CONSTITUTE A FALSE CLAIM ACT VIOLATION AND THE CONSEQUENCES FLOWING FROM THAT EVENT OR EVENTS.
THE CONTINUOUS TREATMENT DOCTRINE —YES — CONTINUES TO FIND ITS WAY INTO AN UNTOLD NUMBER OF COURT DECISIONS. THE LATEST CASE OF INTEREST WAS REPORTED THIS LAST MONTH AND DESERVES REVIEW.
YOU RECEIVE A SUBPOENA FOR THE MEDICAL RECORDS OF ONE OF YOUR PATIENTS. YOU ARE FAMILIAR, OF COURSE, WITH THE HIPAA PROTECTIONS FOR PRIVILEGED HEALTH INFORMATION (PH) BUT YOU ARE CONFRONTED WITH A LEGAL DOCUMENT AND, THE QUESTION THEN IS, WHAT TO DO?
PHYSICIANS MUST BE ALERT TO RESPOND CORRECTLY TO THE MANY QUESTIONS ASKED, NOT ONLY ON APPLICATIONS PERTAINING TO STAFFING PRIVILEGES, BUT, OF EQUAL OR MORE IMPORTANCE, THOSE QUESTIONS ASKED ON RELICENSING DOCUMENTS REQUIRED BY THE STATE.
NEW YORK WAS A PIONEER IN GOOD SAMARITAN LEGISLATION PROTECTING THE RIGHTS OF PHYSICIANS (YES — THERE WAS A TIME WHEN OUR LEGISLATURE WAS CONCERNED IN SHIELDING PHYSICIANS FROM UNNECESSARY LITIGATION!).
WHETHER YOU ARE SIGNING YOUR FIRST EMPLOYMENT CONTRACT OR YOU HAVE BEEN DOWN THIS ROAD BEFORE THERE ARE CERTAIN ISSUES WHICH WE BELIEVE SHOULD BE BROUGHT TO YOUR ATTENTION.
IN THE EVER GROWING WORLD OF AUDIT, COMPLIANCE AND ATTEMPTS AT RECOVERY BY PAYORS THE USE OF STATISTICAL SAMPLING AND EXTRAPOLATING IS FACED BY PHYSICIANS AND THEIR REPRESENTATIVES AS A FORM OF BUSINESS AS USUAL. THAT HAVING BEEN SAID LET US EXAMINE THE MECHANICS OF THE PROCESS TOGETHER WITH ITS PURPOSES AND WHETHER THE PRACTITIONER CAN ANTICIPATE A FAIR AND REASONABLE OUTCOME.
OUR EARLIER REPORT CONCERNING HEALTH CARE PROXIES AND THEIR USAGE TRIGGERED A FLURRY OF QUESTIONS AND WE THOUGHT THAT THE FOLLOWING WOULD BE USEFUL INFORMATION FOR THE PRACTITIONER. THE HOLDER OF A HEALTH CARE PROXY HAS ONLY BEEN GIVEN THE AUTHORITY TO MAKE HEALTH CARE DECISIONS. IN THE ABSENCE OF A SEPARATE POWER GIVEN TO THE DONEE THE HEALTH CARE AGENT LACKS THE AUTHORITY TO CONTROL VISITATIONS OF PERSONS TO THE PATIENT AND LACKS THE POWER TO DETERMINE WHETHER THE PATIENT CAN OR CANNOT EXECUTE LEGAL DOCUMENTS AND THE LIKE. THE POWER HAS BEEN GIVEN TO MAKE HEALTH CARE DECISIONS -PERIOD. OTHER MATTERS MAY OR MAY NOT HAVE BEEN GIVEN TO OTHERS BUT THEY FALL OUTSIDE THE POWERS OF THE HEALTH CARE DESIGNEE.
LET US DISCUSS THE UNPLEASANT TOPIC OF WHAT YOU SHOULD DO IF YOU RECEIVE A LETTER FROM THE OFFICE OF PROFESSIONAL MEDICAL CONDUCT. THE FOLLOWING WILL NOT BE THE NORMAL TYPE OF DISCUSSION YOU MIGHT ANTICIPATE FROM AN ATTORNEY, BUT IT IS RATHER A CONVERSATIONAL PIECE TO TALK ABOUT A TOPIC MOST WOULD PREFER NOT TO CONTEMPLATE.
WE THOUGHT IT WOULD BE USEFUL FOR THE PRACTICING PHYSICIAN TO BE FULLY INFORMED CONCERNING THE USAGE OF HEALTH CARE PROXIES AND THEIR INTERACTION IN THE NORMAL COURSE OF THE PROFESSIONAL DAY.
