Issue 13 - September 2004

The surprising malpractice issues with billing and fees
By Keith Henaman

Deciding to offer a patient free treatment or pursuing payment of unpaid fees can be more complex than many doctors initially think and involves a variety of risk-management considerations.

Here are some situations and suggested ways to proceed:

One of my patients says I caused an injury and wants me to provide free treatment. Should I do it?

Though it’s noble to want to help a patient who thinks he or she has been harmed by your treatment, it is generally not a good idea to offer free treatments to a patient, reimburse a patient for past fees or pay for a patient’s care from another doctor.

If you decide to offer free treatments or reimburse an aggrieved patient for past fees, it could be construed as an admission of guilt. Forgiving care may violate of third-party payor agreements.

If you do decide to offer free treatments or reimburse a patient, do so only in exchange for a patient release. Without a release, not only have you lost that patient’s fee, but you also may be forced to face a future lawsuit.

If you decide to pay for the patient to see another doctor, keep in mind that the patient likely will expect you to pay for any follow-up tests and treatments and may expect free lifetime treatment. With possible imaging studies, surgery, rehabilitation after surgery and similar expenses, this can quickly add up.

Before making any decision, evaluate the situation and the risks. You may conclude that your treatment didn't cause injury.

Is it all right to pursue a patient for unpaid fees?

This is a business decision you need to make for yourself. However, keep in mind that many claims are filed in response to collection action.

If the amount is small, ask yourself if it’s really worth it.

After I refused to waive the fee for a patient, he began bad-mouthing me. Now I hear he plans to sue. What should I do?

Though it’s easier said than done, the most important thing you can do is to keep quiet. Your normal response may be to try to solve this problem. However, this is not a good idea when a malpractice allegation is likely.

The reason you should keep quiet about the situation is because every person you speak with can become a potential witness. If you say different things or explain things differently to different people, your defense could be harmed.

In one case, the doctor phoned an expert who was to going to defend him. Unfortunately, the doctor’s contact with the expert meant he had a conflict of interest and the expert could no longer be used in the case.

Avoid contacting the plaintiff or the plaintiff’s attorney — even when the case involves someone you previously considered a friend or knew professionally. Though your intentions may be benign, a plaintiff’s attorney could misrepresent this contact as a display of guilt, fear or anger. The probability of uttering a potentially damaging statement far outweighs any possible benefit from making such a call.

Finally, do not coach your employees on what to say about the situation. More often than not, anything you tell your employees will come out during a lawsuit — to the detriment of your defense.

Keith Henaman is assistant vice president of claims for NCMIC. NCMIC provides malpractice protection for more than 50 percent of the chiropractic profession and offers an array of diversified financial services. For more information, call 800-769-2000, ext. 349.

Disclaimer: The information provided is offered solely for general information and educational purposes. It is not offered as, nor does it constitute, legal advice or opinion. You should not act or rely upon this information without seeking the advice of an attorney.