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Rogue physicians' behaviors increase hospital risks: ASHRM panel

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Rogue physicians' behaviors increase hospital risks: ASHRM panel

PHOENIX—As hospitals and health care organizations increase their efforts to hire currently self-employed doctors, recent news headlines highlight the increased exposure hospitals face from rogue physicians.

A rogue physician is described as a vicious and solitary doctor operating outside the normal controls of a health care organization, said panelist Linda E. Jones, managing director of the health care practice at consulting firm Riggs, Counselman, Michaels & Downes in Baltimore, during a session this week at the American Society for Healthcare Risk Management Conference and Exhibition in Phoenix.

Some common behaviors of a potential rogue doctor include disruptiveness, patient complaints, sexual misconduct and billing fraud, among others, Ms. Jones said.

Exacerbating the problem is a high tolerance level for disruptive or inappropriate conduct from hospital clinicians, said Susan D. McDonald, director of risk management at Peninsula Regional Medical Center in Salisbury, Md., during the session, “Dealing with Rogue Physicians.”

“There's been a long standard of tolerance in health care” where “nurses have been making excuses for the doctors,” Ms. McDonald said.

Other doctor misconducts that expose health care organizations are violations of the Fraud Claim Act, which prohibits knowingly submitting false or fraudulent claims such as services not rendered, upcoding services, and bundling or unbundling services, among others, the panelists said.

Fraudulent billing is a growing area of concern for risk managers as government statistics show that in the first eight months of 2011 prosecution of federal health care fraud are on pace to increase 85% over last year, Ms. Jones said.

Some risk reduction techniques include a robust corporate compliance program, along with on-going education for medical staff members and leaders, she said.

Peer reviews can also mitigate some of the risks, especially if they're done externally with fresh eyes. Internal reviews can be biased because of established relationships between colleagues, Ms. McDonald said.

Also, Ms. McDonald suggested monitoring any unusual increases in medical billings under one particular doctor, especially with high-priced ticket items like pacemakers, Ms. McDonald said.

Potential insurance coverages to deal with problematic physicians are available, but health care organizations may be declined coverage under their polices for various reasons, such as whether or not the physician is employed with the hospital or is a contractor, Ms. Jones said.

Some of the coverages include directors and officers insurance, professional liability, crime, and electronic discovery coverages.

“It's important to work with the carrier” and notify them as soon as an investigation from the U.S. Department of Health and Human Services' Office of Inspector General is launched, Ms. Jones said.

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