Transcript THE TOP FIVE LEGAL PITFALLS IN EMERGENCY MEDICINE Larry D. Weiss, M.D. J.D.
THE TOP FIVE LEGAL PITFALLS IN EMERGENCY MEDICINE
Larry D. Weiss, M.D. J.D.
Professor of Emergency Medicine Univ. of Maryland School of Medicine
THE “TOP FIVE” PITFALLS 1) liability crisis 2) consent 3) contracts 4) EMTALA 5) billing fraud
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OBJECTIVES
lowering liability • specific consent/refusal • contract problems • EMTALA duties • billing compliance
1. LIABILITY CRISIS Reducing Your Risk: General Principles • • • • avoid conflict disparaging statements option of follow-up specific consent
RISK REDUCTION Proper Documentation 1) be honest 2) worst outcome 3) read nurses notes
RISK REDUCTION Proper Documentation 4) time your notes 5) avoid danger words 6) abnormalities 7) use a diagnosis
RISK REDUCTION Proper Documentation 8) BEWARE: late entries 9) • D/C: continuum of care specify time and action 10) D/C: common liability • eg: NSAIDs, sedatives
2. CONSENT Specific Consent and Refusal of Care • • when to obtain specific consent what to disclose
CONSENT
Maryland Caselaw Sard v. Hardy, 379 A.2d 1014 (Md. 1977) • • material risks objective standard
CONSENT
Maryland Caselaw Dingle v. Belin, 749 A.2d 157 (Md. 2000) • • who will perform breach of contract
CONSENT
Right to Refuse • general rule (Cruzan) • Md. Code HG § 5-613(b) • exceptions • • suicidal incompetent
CONSENT
Refusal of Care • • AMA desertion
CONSENT
Refusal of Specific Consent • • document refusal – use consent form document capacity
3. CONTRACTS Pitfalls • due process rights • restrictive covenants • indemnification • malpractice insurance
4. EMTALA
Emergency Physician Obligations MSE no EMC EMC can’t stabilize no further oblig.
stable no further oblig.
approp. transfer
EMTALA Pitfalls • appropriate MSE • “stability” • unstable transfers • proper certification
EMTALA Pitfalls • economic transfers • “reverse dumping” • don’t delay MSE • “parking” ambulances
5. FRAUD Definition
FRAUD Health Care • false claims • kickbacks • self-referrals
FALSE CLAIMS Definition of a Claim
an application for a payment
FALSE CLAIMS Scienter • •
criminal
• intent
civil
• negligence
FALSE CLAIMS Penalties • $5-10,000 per item/service + up to 3X amount claimed • up to $15,000 for inpt services • exclusion from Medicare
FALSE CLAIMS Health Care • billing company = agent • physician = principal • open books requirement • 42 CFR § 424.80(d)(2)
FALSE CLAIMS Health Care • upcoding • unbundling • improper certification • waiving copayment
FALSE CLAIMS Health Care • service not provided (PATH) • excluded provider • conversion • violating oath of compliance