basic asset protection for doctors: asset protection made simple … asset... · 2017-08-02 ·...
TRANSCRIPT
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Basic Asset Protection for Doctors: Asset Protection
Made Simple
© Copyright 2017. George F. Indest III. All rights reserved.
Presented by:
www.TheHealthLawFirm.com
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George F. Indest III, J.D., M.P.A., LL.M.Board Certified by the Florida Bar in the Legal
Specialty of Health Law
Website: www.TheHealthLawFirm.com
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Main Office:1101 Douglas Avenue
Altamonte Springs, Florida 32714
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
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Objectives• Maintain the focus of your medical practice on
improved patient care rather than malpractice defense
• Structure your practice to reduce liability• Protect your professional and personal assets
from lawsuits • Reduce malpractice insurance costs
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Remember…• The practice of medicine is a service
business – Patients have a right to choose their provider– Payers have a right to choose their panel
members
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Ask Yourself…
• How well does my office represent me?• Are appointments made/kept in a timely
and professional manner?• Do I have a working knowledge of my
patients’ medical records?
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Ask Yourself…• Do my billing and collection procedures
unnecessarily antagonize some patients or give them reason to be resentful?
• Are my medical records complete, legible, and accessible?
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Service Based Disputes• Complaints over cash/elective procedures not covered
– Prequalify – Pre notify of costs procedures
• Charging for:– No show fees– Signing paperwork– Follow up visits to go over lab work
• Not being cognizant of drug costs
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The Grandma Test• Is your policy or procedure something you
would subject your grandmother to?
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Indicators of Potential Lawsuits
• Informal complaints– May be complaints about the quality of care
received– Verify complaints are reported quickly
• Train your staff to escalate complaints
• Medical record requests – Especially by dissatisfied patients
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Indicators of Potential Lawsuits
• Patient conference requests– Could be a prelude to litigation– If patient arrives with an additional person, invite a
staff member to sit in as your witness– Prepare a memorandum outlining the conversation
and place in a legal folder• Avoid communicating with patients by e-mail or letter
unless absolutely necessary
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Indicators of Potential Lawsuits
• Attorney requests– Be wary– Get a valid medical authorization form for
release of information– Avoid discussing the case beyond the release
of the patient’s medical record
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Responding to a Claim• Get legal counsel involved right away• Notify insurance carrier
– First notice should encompass a complete description of the event
– If you report an incident which does not become a claim, neither your standing nor premium will be affected
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Responding to a Claim• Protect the medical records of the patient
– Medical records are your first line of defense– Limit staff access to records– Never alter your records– Your insurance coverage may be jeopardized
if you tamper with medical records
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Responding to a Claim• Cooperate with your insurance carrier
– Be candid– If you believe your actions were within the
acceptable standard of care, let your carrier know
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Responding to a Claim• Develop a legal file
– Keep any correspondence received from the plaintiff’s attorney, your insurance carrier, your defense attorney, and your personal attorney in this file
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Responding to a Claim• Avoid discussion about the claim
– Limit these discussions to your insurance carrier and defense attorney
• No blogging or social media complaining
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Anatomy of a Malpractice Lawsuit in Florida
• Statute of Limitations – Most negligence actions is 4 years – Medical malpractice is actually 2 years– Runs from when the patient knew or should have known that the
injury occurred and that there was a reasonable possibility that the injury was caused by medical malpractice
– Statute of repose may limit claim to 4 years even if the injury and/or cause was unknown
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Anatomy of a Malpractice Lawsuit in Florida
• Pre Suit Requirements – Investigate the claim – Gather records– Get expert review– Get sworn expert opinion – File notice of intent
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Anatomy of a Malpractice Lawsuit in Florida
• 90 days pre suit investigation period• At the end, the physician can:
– Deny the claim– Offer to settle– Offer to arbitrate on damages (requires an
admission of liability)
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Anatomy of a Malpractice Lawsuit in Florida
• Plaintiff files a complaint• Discovery phase
– Written questions– Request for documents– Depositions – Experts hired
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Anatomy of a Malpractice Lawsuit in Florida
• Mediation• Trial date is set at pre-trial conference
– Could be several years away
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Consent to Settle By Physician
• Insurer can’t settle without your agreement
• Amendment to the law permits the policy to allow for physicians to refuse settlement
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Three Strikes and You’re Out• A strike is defined as a final judgment by a
court or agency that has been supported by clear and convincing evidence
• Any doctor hit with three qualifying malpractice judgments will have his/her medical license revoked automatically
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Strike Occurs After:• A final order of an administrative agency
following a hearing where the doctor was found to have committed medical malpractice
• A final judgment of a court of law entered against a doctor where the licensee was found to have committed medical malpractice in a civil court action; or
• A decision of binding arbitration where the doctor was found to have committed medical malpractice
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Reducing Malpractice Risk• Stay current• Spend the time• Serve your patients needs medically,
personally, and financially• Document, document, document
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Asset Protection
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Insurance Coverage• Insurance coverage through a reputable
carrier with appropriate limits is the best asset protection you can get– Malpractice insurance– Premises liability insurance– Umbrella coverage– Excess/Secondary coverage
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Business Entities• Why form a company?
– Offers protection for your personal assets• Caveat:
– Must observe the “corporate form”• i.e. treat it like a business and not your piggy bank
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Layers of Protection• Using multiple business entities can add
additional layers of protection• Place all significant assets in separate
business entities– Expensive equipment– Building and/or property
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Spouse or no Spouse• Depending on the law in your jurisdiction it
may be advantageous to own your practice with a spouse or even children
• However, there is considerable disagreement among asset protection planners on the subject
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Other Methods of Asset Protection
• Have your spouse sign for a child’s driver’s license
• Carry sufficient auto insurance• Disability insurance• Avoid excess liability in other business
endeavors
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Structuring Your Practice
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Health Care Clinic Act
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Health Care Clinic Act• Requires clinics with lay owners to be
licensed by the Agency for Healthcare Administration
• Applies: If ANY portion of the business is owned by a non-exempt person
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Traps for the Unwary• If a non-exempt person owns the clinic, practice,
or facility.• If a non-physician controls all major decision
making for the clinic, practice or facility.• If all financial matters are controlled by a non-
physician.• If a corporation or LLC owns the clinic, practice
or facility.
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HCCA Consequences• Third-degree felony with each day of operation • If an individual has an interest in more than one
clinic, AHCA may revoke the license for all of the clinics
• Administrative fines of up to $5,000 per day• Potential recoupment of claims made to third-party
payors
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Keep in Mind• Some health professions prohibit ownership
by anyone outside of that specialty• Examples include:
– Dentistry– Optometry – Chiropractic medicine
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Defensive Medicine
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Defensive Medicine• Ordering potentially unnecessary medical
tests, procedures or consultations to protect the physician from accusations of negligence
• 75% of physicians report practicing defensive medicine
• About $650 billion spent annually
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Pitfalls of Defensive Medicine• Delays in patient care• Increased expense in patient care• Expose patients to unnecessary risks• Damage doctor/patient relationship• Exposure to other liability such as audits
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Protect Yourself• Documentation• Follow-up• Procedures• Patient relations
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Protecting Your License
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The Initial Complaint Sources• Disgruntled employee/employer, colleague/coworker,
patient/family member• Code 15 or adverse incident report• Agency for Health Care Administration (AHCA) surveys• Law Enforcement• Self Report or Adjudication• Malpractice Allegation• National Practitioner Date Bank (NPDB)• Other
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Common Allegations in DOH Complaints
• Unprofessional conduct (e.g. disruptive physician)• Failure to practice with reasonable skill and safety• Criminal conduct• Engaging or attempting to engage in the possession,
sale or distribution of controlled substances• Filing a false report• Malpractice settlements
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Collateral Consequences of License Discipline
• Discipline remains on the medical license forever• Will usually precipitate an investigation and/or discipline
by other states where the physician holds a license • When discipline is imposed, the physician generally has
an affirmative duty to report to other states where a license is held
• Could serve as a basis for exclusion from Medicare/Medicaid programs
• Will generate a NPDB report
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Main Office:1101 Douglas Avenue
Altamonte Springs, FL 32714
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
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Orlando Office (By Appointment):
37 North Orange Avenue, Suite 500Orlando, Florida 32801
Phone: (407) 331-6620Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
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Pensacola Office (By Appointment):
201 East Government StreetPensacola, Florida 32502
Phone: (850) 439-1001Fax: (407) 331-3030
Website: www.TheHealthLawFirm.com
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Denver, Colorado Office (By Appointment):
155 East Boardwalk Drive, Suite 424Fort Collins, Colorado 80525
Phone: (970) 416-7454Fax: (866) 203-1464
Website: www.TheHealthLawFirm.com
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SM The Health Law Firm is a registered service mark
of The Health Law Firm, P.A., Altamonte Springs, Fla.
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© Copyright 2017. George F. Indest III. All rights reserved.(No rights claimed for any property or images of others.)