Tips from a health care attorney
Congratulations for making it through medical school, and residency, and perhaps even a fellowship. Now — finally! — you’re ready for your first or second job. You may be clinically prepared, ready to see patients and begin procedures, but are you ready from a practice management perspective? In my experience, there are four areas that trip up new doctors the most.
Negotiate contracts, find out what you are worth, and know how to slow things down and advocate well for yourself. Understand expectations. Are you supposed to supervise advance practice providers (APPs)? Is the compensation and bonus structure easy to understand? Are you meant to be on call nights and weekends? To see patients 34 hours per week in the office? Are there certain productivity expectations? Do you have sufficient paid time off and reimbursement for continuing medical education? You need to fully understand what is expected and see whether it’s reasonable or something you must negotiate.
And find a way out. Your first job is unlikely to be your last, so find a way that you can exit the agreement within a certain notice period, like 90 days, without any strings attached. Then think about what will happen when you do leave. Is there a tail policy you have to pay? A penalty? A noncompete agreement? Think about all these factors before you sign.
Fraud and abuse
You go into practice well trained in medicine but often have no clue about what business relationships can get you into trouble or what to avoid. Remember this: If it’s too good to be true, it is. If someone is giving you money for not much work, if something smells funny, if there is an underlying motive, be cautious. As a physician, you are an especially attractive target for kickback schemes because you can be a source of referrals for fellow physicians and other health care providers and suppliers. Patients trust you. If you tell them to use a certain lab or drug, they will. Companies want your patients and their business and will incentivize you however they can so that you send business their way.
Be careful about relationships with labs, medical director agreements, and revenue-sharing arrangements. Don’t just share space or resources with anyone you refer. There are many well-meaning physicians sucked into fraudulent schemes disguised as legitimate business deals. Usually, the doctors involved are approached by a sophisticated and well-appointed company with a “shiny” proposal and big law firm opinion of support, assuring them that everyone else is joining or signing up. Never believe such assurances. Ask questions and get your lawyer to review it. It’s money well spent to not have to unwind an illegal deal.
Never act on the say-so of someone else’s lawyer, another doctor, or another partner without doing your own homework. Trust, but verify. You don’t always have to tell a potential new partner or employer that you’re calling your attorney for advice. Your communication with him or her is privileged and confidential, and they can be a sounding board for you. Many times, I end up writing the emails my clients send or raise red flags that my clients raise, and no one else knows that I exist. If you don’t have a good relationship with your lawyer, find a another one. But think about it when someone says, “This has been vetted by legal.”
Who does that lawyer work for? If it’s not you, get your own opinion.
You don’t want to be the office tattle, but what if you start to see something that sounds an alarm? How do you handle it? If you’re working for a small group, make sure they have a compliance plan. Make sure there are some basic billing and coding audits. Hiring your own auditor is a good thing! So many doctors think they know how to bill and code but end up making mistakes, and that can really cost you. Remember that if your partners are messing things up, it can redound on you as a member of the company. If your APPs are billing under your national provider identifier and not following the incident-to rules, that will affect you. You don’t have the luxury of burying your head in the sand.
Amanda Hill, JD, is a health care attorney based in Austin, Texas, and founder of Guard My Practice, an online video platform for doctors offering 15-minute weekly sessions that guide them through complicated subjects as contract negotiations, fraud and abuse issues, employment conflicts, and more.