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

QUESTIONS?