Practice Management Q&A (Medical Economics Special Section)

September 1, 2007

Questions and answers relating to practice management.

Must you appear in court?

I just received a subpoena. It says "Issued by the United States District Court," but it's signed by an attorney, not a judge. Do I have to appear?

Probably. If the subpoena was properly served and meets all the court's rules, you have to appear even though it was not signed by a judge. In many states, subpoenas are commonly signed by a lawyer without any court involvement.

One caveat: If the case involves a suit against you, any communication demanding your appearance or records should have been sent to your lawyer, not to you personally. So, if you are party to this litigation, don't speak with the lawyer who issued the subpoena. Notify your own attorney.

No referral, no appointment?

I'm a gastroenterologist who belongs to a PPO plan that allows patients to make an appointment with a specialist without a referral. Does this oblige me to see them, or can I insist that they obtain a referral from their primary-care doctor first?

If you signed a contract with the PPO agreeing to see patients without a referral, expect consequences if its enrollees complain that you refused. The PPO may drop you from its panel. But, on the other hand, you have your own professional obligations to uphold; for example, making sure there's a primary-care doctor in the picture to send the patient back to for follow-up care. From an ethical point of view you can require a referral because determining criteria for accepting patients is your responsibility as a physician, not the plan's.

How you resolve the conflict between your contractual and professional obligations is up to you. By all means call the PPO and remind them that under a "standard" PPO contract, there's no express or implied duty to see patients without a referral. Ask a plan representative to clarify exactly what they expect. Perhaps the referral rule may not apply in all cases. Or discuss your concerns with colleagues in your specialty, who probably have encountered self-referred-patient problems similar to yours and can offer advice.

The answers to our readers' questions in the previous section were provided by: Ellis I. Kahn, JD, Kahn Law Firm, Charleston, SC; David Karp, David Karp Associates, Cloverdale, Calif.; Steve Kern, JD, Kern Augustine Conroy & Schoppmann, Bridgewater, NJ; Michael LaPenna, The LaPenna Group, Kentwood, Mich.

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.

However, if a patient accused you of intentionally breaching her privacy and the claim wasn't part of a medical malpractice suit, your malpractice insurance wouldn't cover you.

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.