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Watch out for People-Related ‘Gotchas’

Wyn Staheli, Director of Content - innoviHealth

In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are people who are looking for ways to damage your practice. This can be patients, employees, or even competitors. Protect your practice by being vigilant and implementing good compliance programs.

The following are a few reminders of concerns that need to be addressed in your practice.

Patient Issues

  • Unexpected bills. Patient’s can forget about visits and may assume that insurance covers everything. Implement a policy of helping patients understand their financial responsibility and help them understand what their insurance does and does not cover.

  • Disability laws. You need to ensure that your facility meets all state and federal disability standards. Document your due diligence in meeting these laws in your office’s Policies and Procedures manual.

  • Nuisance claims. We heard of a situation where someone filed a lawsuit claiming that asking the patient about their HIV status violated their right to privacy. As a medical provider, you need to know that information. Of course the case was dropped after attorney’s for the professional organization got involved, but this only emphasizes the need to make sure that you know a good healthcare attorney.

Employee Problems

  • Complaints. If your employee tells you that they think that there is a problem, you need to listen to them.

    • Officially investigate their complaint and document the resolution.

    • Be sure they know that you listened and investigated and that they understand the resolution.

    • Have them sign a document which states that they understand the resolution.

I am aware of a case where the employee was upcoding claims. The provider only verbally told the person to stop doing that. He later fired the individual who then filed a whistle blower complaint. Unfortunately, this provider did not have sufficient documentation to backup his statements that he had reprimanded the employee and he ended up facing big penalties.

  • Social media. HIPAA has strict rules regarding PHI and some employees may not be aware that their social media postings violate HIPAA. For example, one employee posted a picture of themselves sitting at their desk and their computer screen was visible. Posting a picture at work isn’t a problem, but the problem was that the screen showed patient information. Be sure that your HIPAA training includes social media pitfalls.

  • Snooping. This is particularly problematic when the employee knows the patient or wants to know the patient (e.g., friends, famous people). The employee may only access that patient’s chart if their medical responsibility requires access to it. Physician’s Practice recently wrote an article about this problem and the pitfalls and fines that can be incurred. (see References).

Make sure you take time to address these issues. Ensure that all staff are educated about these pitfalls and that your Policies and Procedure manual covers these topics.