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More Difficult than Ever Before
By Brian J. Knabe MD, Certified Medical Planner
Historically, the term “risk management” has brought to mind one subject for the practicing physician – medical malpractice. Unfortunately, physicians today face a multitude of other risks which may be more insidious and daunting than malpractice. It is important to recognize these risks, and to have the appropriate procedures and policies in place to mitigate the risks. These risks come from the federal government, state government, insurance companies, patients, employees, and even prospective employees. Some risks, many unique to small businesses and medical practices, include the following:
- Medicare recoupment risk – challenges to coding and subsequent billing by the physician.
- Medicare fraud. Numerous laws can be used by the federal government to go after the physician, including the Medicare and Medicaid Anti-Fraud and Abuse Statute, the RICO statute, and the Federal False Claims Act. The recently enacted Patient Protection & Affordable Care Act aims to save money by increasing funding for anti-fraud efforts.
- Insurance fraud. An inquiry from Medicare to look for fraud in a physician’s practice is often followed by similar efforts by insurance companies.
- The HIPPA Act of 1996 creates new definitions and penalties to use against the physician.
- Self referral risks. Federal regulations in this area include the Medicare Anti-Fraud and Abuse Statute, the Medicare Safe Harbor Regulations, and the Stark Amendment.
- Federal agency risks. These include regulations from the Occupational Health and Safety Agency (OSHA), Health and Human Services (HHS), the Drug Enforcement agency (DEA), and even the Environmental Protection Agency (EPA).
- Anti-trust risks. The Department of Justice (DOJ) and Federal Trade Commission (FTC) formulate regulations in this arena.
- Managed care contractual risks. Most managed care contracts require the individual physician rather than the professional corporation to sign the contract, thus placing the physician’s personal assets at risk.
- Medical malpractice risks. Although the vast majority of claims are paid by the insurance carrier, there can be other adverse consequences for the physician. These include the risk of increased premiums, non-renewal of policies, and difficulty in getting replacement insurance.
- Loss of income due to death or disability. Most physicians recognize the importance of life insurance, but the medical professional is actually much more likely to lose income due to disability at some point in his or her career.
The practicing physician should seek the advice of professionals with expertise in these areas. Every practice should have an experienced attorney on retainer. It is very important to seek advice from fiduciaries – experts who have no conflicts of interest and who can therefore act in the best interest of the client. A Certified Medical Planner is such a fiduciary with training and expertise in these areas.
http://www.CertifiedMedicalPlanner.org
It can be particularly challenging to find an insurance advisor with no conflicts of interest, as this industry is built upon product sales and commissions. One such insurance advisor is Scott Witt, a fee-only insurance advisor with Witt Actuarial Services (www.wittactuarialservices.com).
Others can be found with an internet search for “fee only insurance advisor”.
Conclusion
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Filed under: CMP Program, Experts Invited, Op-Editorials, Practice Management, Risk Management | Tagged: brian knabe, CMS, DOJ, financial advisors, FTC, HHS, HIPAA, insurance agents, Marcinko, medicare, Medicare compliance, National Association of Personal Financial Advisors, OSHA, RICO, www.certifiedmedicalplanner.com | Leave a comment »
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