Practice Management

The 4 Most Likely Ways Your Practice Will Get Into Legal Trouble

By Ben Gonzalez, JD

June 30, 2021

Practice owners have a lot on their plate. Providing quality care to patients, procuring the best products and recruiting staff are not your only responsibilities. Avoiding potentially costly legal challenges is another huge area of management responsibility. Here are four of the most common ways practice owners get themselves–and their businesses–into trouble.

Like any legal matter, it is best to consult employment lawyers and provisions of your state’s optometric board before taking any action.

Negligent & Incompetent Staff
Employees control the scheduling of incoming patients, oversee optical sales, and are the first touch-point for patients e-mailing or calling with questions or appointment requests. In addition, they reiterate and explain the doctor’s diagnoses and prescriptions to patients. These responsibilities give them enormous power over patient communications. As such, they are your first line of defense against lawsuits and sometimes the cause of lawsuits if they are negligent.

For example, legally perilous staff negligence could take the form of a staff member who does not consult with the doctor about the appropriate scheduling for a patient calling with an eye health concern, deciding themselves that the patient can wait a few months to see the doctor. That patient’s vision is then adversely affected, or maybe there is even a loss of vision. This kind of bad patient outcome could prompt a lawsuit.

The best way to avoid employing a negligent staff is by hiring individuals with a track record of responsible work performance and by delivering thorough training. Employees need to be taught a protocol for what to do when a patient calls with an eye health or vision concern. They should understand what constitutes the need for immediate, emergency scheduling, what can wait, and to always consult the doctor if they are not sure.

Apart from meeting the prerequisite education requirements for each position in your office, you should ensure that employees demonstrate competency. A tactic that works wonders is asking employees to show you, or an office manager, how to do the most important tasks that are part of their job. You can tell how much a person knows about something when you watch and listen to them try to teach another person how to do it.

Yearly refresher courses and continuing education will make it more likely employees remember everything they need to remember, and that they have the latest knowledge of all subjects they need to be well-versed in.

Incorrect Billing
Overcharging your patients or billing their Medicare incorrectly may subject you to surprise audits from the federal government. Insurance companies covering your patient may also institute a surprise audit on your practice if your bills are increasingly being rejected or kicked back.

While over-billing is a serious legal offense, under-billing is also a legal concern. Even though it doesn’t benefit you financially, inaccurate billing could trigger an immediate audit, and your practice could lose its position on the insurance company’s panel.

The best way to avoid this legal problem is to provide basic training to employees on coding and billing procedures. Additionally, practice management should routinely review insurance claims and compensations made to your practice. Reconcile all procedures done with the bills and compare with the money paid by insurance companies to your business. If there are unexplained blanks, inquire from your staff and resubmit the claims immediately.

 Failure to Document or Improper Documentation
Proper, consistent documentation in your patients’ health records helps you provide good care and protects your practice from liability. Just as hospital records can be admitted as valid court documents if a patient presents a claim in case of complications or adverse reactions to drugs prescribed by physicians, so, too, can your records be used to defend your practice in court.

Develop and enforce a strict documentation policy that guides employees on the most important details that should be captured during interactions with patients. And be sure you, as doctor, are doing the same you are asking your employees to do in adequately documenting all interactions with the patient.

Dangerous Workplace Environment
All businesses, including healthcare practices, should follow construction provisions that make it safe for employees and patients. Uneven floors or frayed wires that can trip people or cause an electrical shock are dangerous and violate Occupational Safety and Health Administration (OSHA) standards.

It is important to inspect your business premises routinely. Identify and solve potential problems, such as lose footing and unsafe floors, which can cause injuries to anyone, and especially patients with impaired vision or other disabilities. Additionally, keep dangerous hazards, such as poisonous cleaning solutions, out of reach of patients and other visitors to your office.

Ben Gonzalez, JD, is a UC Berkeley School of Law graduate. He is currently a freelance lawyer based in San Francisco and a contributing writer for HKM Marketing.

 

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