Practice Management Q&As

December 15, 2006

Moonlighting; breach of privacy; out-of-state Medicaid patients

Malpractice coverage for breach of privacy?

Would my malpractice insurance cover me if a patient sued for breach of privacy?

Perhaps. It depends on the specific language of your policy, which may cover breach of privacy allegations that claim you acted negligently. Or if the breach of privacy claim were part of a larger malpractice suit, your malpractice carrier would probably provide a defense against all charges.

Accepting out-of-state Medicaid patients

We participate in our state's Medicaid program. Are we required to accept out-of-state Medicaid patients? We recently saw a patient covered by another state's program and were denied payment.

No, you're not required to accept out-of-state Medicaid patients. And many physicians refuse to because of the very problem you ran into: difficulty getting paid. States have different rules. A state may require an out-of-state doctor to enroll in its own Medicaid program in order to be paid. Often, the administrative burden of filing a claim is so onerous that doctors find it's not worth the effort to pursue payment.

A two-year wait for a signing bonus?

I've been offered a contract that states that I'll lose my entire signing bonus if I leave before completing 24 months of employment. That seems like a long time to me. Is this customary?

It's not customary, but our experts feel that this policy isn't unreasonable from your employer's point of view. It costs the practice a lot to recruit and train you, and then support you financially (possibly through an income guarantee) until your productivity increases to the point where you can carry your own weight. Perhaps you can negotiate a provision whereby you'll receive 1/24 of your bonus for each of those first 24 months of employment.

When a valuable, staffer quits

My nurse gave notice today. She said our management style was just too unstructured for her more organized temperament. I'd like to send her a letter just to document what happened and assure her that I have no hard feelings. What should I say?

Keep it cordial and professional. If she's done a good job, acknowledge that and thank her for her assistance.

If she was a valuable employee, it might be worth inviting her back to sit down with you and your office manager to discuss office procedures. She may be right that more structure and oversight are needed in certain areas. Listen to her with an open mind.

Moonlighting at a nursing home

With my employer's blessing, I plan to start moonlighting at a nursing home. How should I bill for the work I do there? Is it better to incorporate and bill under the corporation's name, or should I just bill under my own name? Will my malpractice insurance cover my moonlighting activities?

Form a single member LLC (limited liability company) and bill under the name and tax ID number of the LLC. Like a corporation, an LLC will shield your personal assets from being claimed in a nonmalpractice lawsuit, but it's easier to form and cheaper to operate. Your malpractice insurance will probably cover your work in the nursing home, but check with your carrier to make sure.

Can you ignore an unreasonable subpoena?

Am I required to appear in federal court on an attorney's subpoena when the attorney gives me only two working days' notice?