Employment Lawsuits

by On 7 Comments In , ,

Avoiding Employment Threats
After over a decade of educating Doctors on the importance of asset protection, we are seeing a noticeable increase in awareness. Unfortunately, the majority of Doctors who fail to employ asset protection planning give the same excuse: “Doctors never lose malpractice lawsuits with awards above coverage limits.” This is wrong for two reasons. First, half of jury awards against physicians are over $1,000,000. Second, malpractice suits are only a small percentage of the awards against Doctors. A less visible but arguably larger concern is that an employee will file a suit against the Doctor. In the larger version of this article, we will discuss the challenges of employment liability, which may result in very expensive defense costs—even in the event of fraudulent cases that you win. We will give some examples of cases that may be of interest, explain increased risks in the information age and offer some solutions.

The Risk Of Employment Lawsuitspost 13
Over the past 20 years, there have been monumental changes in the employment arena. There are a host of Federal Laws that have been put in place to protect employees’ rights and open the possibility for lawsuits against employers. Many argue that these laws are appropriate to protect the rights of workers while employers often argue that these laws place undue restrictions on their ability to manage their firms.
Regardless of which side of the issue you sit, the reality is that there are numerous “Laws of the Land” which employers must follow. Inclusive of these are the FLSA [Fair Labor Standards Act]; the ADA [Americans with Disabilities Act]; FMLA [Family Medical Leave Act]; Title VII of the Civil Rights Act of 1964; The Civil Rights Act of 1991; and many more. In addition to the federal law, California’s laws add another layer to these regulations. So what does it all mean? It means that you have to learn how to protect yourself against one of the fastest growing areas of liability.
What many employers—including Doctors—face today is the challenge of working in an ever increasingly complex world of employment regulations and guidelines. Most small business owners may have few resources with which to address human resources concerns and little or no training. This can result in the owner being held financially responsible for any mistakes they may make. It means that age-old established practices may plot a course for a company to end up in ruin. It means that business owners—including Doctors—must pay greater attention to how they hire employees; how they supervise them; and how they terminate them.
This environment has fueled the growth of Human Resources (“HR”) outsourcing. Many firms have established themselves as specialized providers of these functions for businesses, with the intent of alleviating the business owner’s HR headaches. While these firms do provide reliable HR services, they typically do not provide liability coverage for the companies they serve, especially in the realm of employee suits claiming sexual harassment, unlawful termination or discrimination. So, while business owners may benefit from outsourcing some HR tasks, they cannot outsource the risk and their companies are still responsible for their own actions. Insurance policies that address these risks are available to protect against catastrophic liability—one example is EPLI [Employment Practices Liability Insurance], also known as HIRE insurance (see www.hireins.com for more information). If the risk is real, and protective insurance is available, why are the vast majority of small business owners, including Doctors, operating without such coverage?
To small business owners, this type of coverage has historically been out of reach due to cost restrictions. Thankfully, this is now beginning the change. More affordable coverage solutions are making their way into the market. In fact, low deductible policies with coverage amounts as high as one million dollars can now be found. These more accessible policies, coupled with employment risk management services, provide a shield that can protect small business owners—including Doctors—from these potentially devastating claims.

Protecting Your Practice
There are two ways to protect your practice assets from risks. First, you can insure against the risk, effectively sharing the risk and passing it along to someone else. Second, you can assume the risk yourself and use asset protection and risk management strategies to protect assets from the threats. The second strategy is covered in Lesson 6. Here we will focus on passing off all of that risk to other people through insurance.
Fewer than 5% of small businesses (and, we imagine, even fewer medical practices) have any insurance coverage providing protection from employment-related lawsuit risks. This is despite government statistics clearly indicating that this threat is a growing problem. Additionally, recent federal court rulings have begun finding owners and management “personally liable.” This means that just incorporating a business will NOT, by itself, protect a business owner from being found personally and financially liable in employment-related suits. Thus, insurance coverage is key to protecting a business owner’s interests.
A solid EPLI policy coupled with a comprehensive risk management course can be obtained today for under $2,500 (sample for businesses of 10 employees or less). Retaining these services provides small business owners with the tools necessary to enforce the protections of the insurance coverage. By coordinating an insurance policy and consulting services, the small business owner/Doctor can expect to see a significant reduction in the threat posed by an employment lawsuit. Contact the authors at 877-656-4362 for more information.

Risks In The Information Age
Information is the currency of modern America. The role of the Internet—and its ability to locate and distribute information—has exploded in recent years. It has become the source of much of our information—our de facto provider of answers, so much so that the first thing a person will do when faced with a potentially life-changing issue is often to “Google it.”
What else, then, would you expect of an employee that feels they were treated unfairly? Most likely, they will explore the information available online and learn that they may have options available to them. In More

by On 7 Comments In , ,

Avoiding Healthcare & Insurance Issues
Before we can show you how to turn your practice into a Fortress and an Engine in the next Lesson, we have to show you what to avoid in your practice so that you don’t cause any insurmountable financial damage to yourself or your practice. In addition to personal lawsuits, Doc-tors need to worry about business issues as well. This is consistent with our previous discussions about the “business of medicine.”
Many physicians have a false sense of security and believe that malpractice insurance will protect them from lawsuits. We agree with you that a medical malpractice claim is not “likely” to result in a significant depletion of your estate. However, if you go to trial and lose, you could be in serious financial trouble. According to Current Award Trends in Personal Injury (Copyright 2007), half of all jury awards for medical malpractice claims in 2005 exceeded $1,184,000. The average medical malpractice jury award in 2005 was $3,830,000. If you consider that most doctors carry $1 million of per occurrence medical malpractice liability insurance, half the doctors who lose a judgment will be out at least $200,000 and the average personal loss from a judgment will exceed $2.8 million of the doctor’s own money (after insurance has paid its limits).
In addition to medical malpractice threats, there are unexpected risks that carry an even higher likelihood of causing asset depletion. As a Doctor, business issues include liability for your business as well as liability that may result from regulatory issues and administrative investigations (i.e., OPMC, HCFA, Stark, HIPAA, OIG, etc.) and contract issues (i.e., Medicare Medicaid Fraud investigations, over-billing claims, and refund audits from insurance companies). These types of claims are increasingly overshadowing the threat of medical malpractice because, unlike malpractice risks, they are usually not covered by insurance, leaving the physician to privately fund the defense costs out of pocket. In addition, mistakes in regulatory issues can even land a Doctor in jail. No other risks in this book carry such a serious threat.
In this chapter, we will discuss some of the specific healthcare and insurance related risks, explain how they can be avoided, and offer suggestions on how to protect yourself from mistakes that may occur even when you do your best to avoid them.

Employee at Mac ComputerHIPAA
The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was originally en-acted to enhance (not guarantee) certain health care insurance coverage for Americans. HIPAA also creates a national, standardized set of rules for maintaining (security) and protecting (confi-dential) patient medical information known as PHI (Protected Health Information). The failure to institute a good faith and reasonable office compliance program, to provide privacy notice to patients concerning their rights, to protect against the unauthorized release of confidential records and implement security safeguards for data in transit and maintained in the office could potentially place physician owners, their employees (including administrative office staff) and even business associates at grave risk for monetary fines and even criminal penalties for the unauthorized disclosure of PHI which is enforced by the OCR. Such penalties and sanctions could include civil penalties and fines for each violation ($100 per violation with a maximum penalty of $25,000/year for identical penalties) and for intentional violations of the law could even include criminal penalties (i.e. fines between $50,000—$250,000 and imprisonment terms from 1 to 10 years).

Over-Billing Issues
A key operational element in the business of medicine is the process of billing, coding and collecting professional fees from insurance companies. In some cases the payers are insurance companies and in other cases, the payers may be Medicare or Medicaid. Aside from the United States tax code (which we will call the most complex system of rules in the history of mankind in Lesson #7), the Medicare coding system may be the most complex system of rules ever created.
Despite best efforts to train administrative staff, medical offices are regularly audited by insurance companies, Medicare and Medicaid. These audits routinely result in claims of over-billing. Many Doctors fight a losing battle against the large insurance companies (and their teams of attorneys) and ultimately have to surrender funds they previously collected for services rendered. Unfortunately, when the audit comes from Medicare or Medicaid, Doctors have more to lose than just money. A Doctor found guilty of Medicare fraud can actually go to jail. Because of the significant costs resulting from both Medicare fraud and commercial insurance carrier audits, we will examine them both separately.

Medicare Fraud
Anyone who provides, or receives, healthcare services, could commit Medicare fraud. Fraud is defined as an intentional deception or misrepresentation that someone makes, knowing it is false, that could result in the payment of some unauthorized benefit. Abuse, on the other hand, involves actions that are inconsistent with sound medical, business, or fiscal practices. Abuse di-rectly or indirectly results in higher costs to the Medicare program through improper payments that are not medically necessary. In the eyes of investigators, fraud and abuse both have the same effect. They steal valuable resources from the Medicare Trust Fund that would otherwise be used to provide benefits to Medicare recipients.

Fraud Investigations
The federal law enforcement agency responsible for investigating Medicare fraud is the Department of Health and Human Services, Office of Inspector General (HHS-OIG). In some cases, HHS-OIG may involve other agencies, such as the Federal Bureau of Investigation (FBI), the Internal Revenue Service (IRS), or the Postal Inspection Service.
Many complaints are simply misunderstandings or billing errors and can be resolved fairly easily. Some complaints help identify abusive billing practices. The Medicare contractor will educate the health care provider, collect any overpayment, and then follow up to make sure the provider does not make the same mistake again. Other complaints involve Medicare fraud. These cases often require long, complex investigations by federal law enforcement agencies.

Penalties
The U.S. Attorney General’s office targets health care providers for civil and/or criminal prosecution. Some of the penalties for someone convicted of Medicare fraud are listed More