When would a jury find a doctor guilty of medical malpractice?

Tue, 24 Mar 2009 19:44:36 GMT

A jury may find a doctor guilty of medical malpractice if the plaintiff proves that the doctor was negligent under the law. Some common scenarios that result in findings of medical malpractice include the failure to diagnose a condition, the failure to provide appropriate treatment for a diagnosed condition and an unreasonable delay in treating a medical condition.

No matter what the particular facts of the case are, a doctor may only be found guilty of medical malpractice if the plaintiff proves the following four elements of his or her case: (1) that the doctor had a legal obligation (also known as a duty) to provide care to a patient; (2) that the doctor failed to provide the standard of care that a similarly situated reasonable doctor would have provided under the same circumstances; (3) that the doctor’s actions were the proximate cause of the patient injuries; and (4) that the patient incurred damages as a result of the doctor’s actions. If the plaintiff is successful in proving all four elements of the case, as described above, then a doctor will be found guilty of medical malpractice.

How can I defend myself against a medical malpractice claim?

Tue, 24 Mar 2009 19:45:17 GMT

In order to successfully defendant yourself against a medical malpractice claim you must prevent the plaintiff from proving a required element of the plaintiff’s case. Successful defenses include proving that you did not have a legal obligation to provide care to the patient because a doctor patient relationship did not exist. Another successful defense would be that you provided the same standard of care that a similarly situated reasonable doctor would have provided in the same circumstances. If you acted as any reasonable doctor in your situation would have acted then you are not responsible for medical malpractice even if the patient was harmed. Finally, if the patient did not suffer any harm because of your actions then the plaintiff cannot be successful in a medical malpractice action.

What are Medicare Anti-Mark Up Rules?

Tue, 24 Mar 2009 19:45:54 GMT

Medicare’s new Anti-Mark up Rules went into effect on January 1, 2009.The Medicare Anti-Mark Up Rules are meant to prevent the mark up (price increase) of certain diagnostic tests that are conducted by outside suppliers and billed to Medicare by individuals or entities who do not share a practice with the patient’s physician. The rules limit how much outside entities such as diagnostic labs and pathologists can bill Medicare for diagnostic testing that was not done by a physician sharing a practice with the entity that is billing for the diagnostic tests.

What are the potential penalties for Medicare fraud?

Tue, 24 Mar 2009 19:47:41 GMT

Physicians or health care entities that are found to have committed Medicare fraud face serious consequences. They will be required to repay the Medicare overpayments which they received and they are likely to face significant financial fines as well. Further, they may face criminal prosecution by the federal government. The United States Attorney’s Office can prosecute health care providers for alleged Medicare fraud under a variety of statutes such as the False Claims Act, False Statements Act and Social Security Act. Penalties for violations of these acts include prison terms and monetary fines. The typical prison term is up to five years for each offense.

What are the potential penalties for a HIPAA violation?

Tue, 24 Mar 2009 19:48:36 GMT

The Health Insurance Portability and Accountability Act (HIPAA) provides federal standards for the privacy and security of personally identifiable medical information. A person who knowingly violates the provisions of HIPAA may be subject to a fine of $50,000 and / or 1 year in prison for each offense. If the offense was committed under false pretenses then the fine may be raised to $100,000 and the prison term may be increased to 5 years in prison. Finally, for the most egregious HIPAA violations where the offense was committed with the intent to sell, financially benefit or maliciously use someone’s personally identifiable medical information the fine can be raised to $250,000 and the prison term may be increased to 10 years in prison. Smaller civil fines of around $100 per violation may also be imposed.

What should I do if I'm audited by Medicare?

Tue, 24 Mar 2009 19:47:01 GMT

While a Medicare audit should not be cause for panic, it should be taken as seriously as an IRS tax audit. Medicare can audit physicians in one of two ways. Physicians can be audited in “pre-payment audits” where Medicare workers randomly examine physician records that have not yet been submitted to Medicare or physicians can be audited in “post-payment audits” which is a review of claims that have already been submitted for Medicare reimbursement. The majority of Medicare audits are conducted by mail but sometimes a federal agent will come to your place of business in order to conduct the audit.

It is very important that all of your patient charts and billing records are well organized and easy to review. If the Medicare carrier who is conducting the audit finds a discrepancy between what you have billed Medicare and the actual cost of the medical services provided then you typically have three options. You can pay the assessment requested by Medicare, you can waive your right to appeal and submit evidence that the carrier’s conclusions were incorrect or you can request that the carrier look at a larger sample of your charts and records and maintain your right of appeal. If a Medicare carrier finds one instance of a billing error then Medicare is likely to instruct you on the importance of proper billing and request a refund for overpayment on that case. However, if a Medicare carrier finds a trend of overpayments then you may be facing repayment of significant amounts of money as well as civil and criminal penalties.

Since the potential penalties are so serious, it is important that you contact your attorney as soon as you receive notification that Medicare will be conducting an audit. Your attorney can help you and your staff adequately prepare for the audit.