Re: Patient won't pay bill & threatens lawyer

February 8, 2008

So sorry about that. Do call the malpractice company.....it is

their job to advise in these situations and I think they will give you

advice without additional charge (that's what we pay the big bucks for

all year).

The lawyer doesn't think he/she has a case or he wouldn't let you off so

easy, but, like Gretchen says, being right doesn't help a lot if you have

to spend a lot of time and emotional energy on a depositions, worry,

court time. Do what you need to do to get it out of your psyche

(run, write her a nasty letter then burn it, vent to us, as my mom used

to say, " offer it up, " whatever). But get it over and be

done.

Sharon

At 09:22 AM 2/8/2008, you wrote:

Call your attorney/malpractice company ASAP! No amount of money is worth

being right (which I’m sure you are). Anyone out there who has been sued

(as I have, but completely vindicated) will tell you it’s definitely

worth it to make her happy. You REALLY want this to be over with, trust

me…no matter how right you are and how abusively stupid she is.

Gretchen Reis MD

Wellspring Family

Medicine

Circleville,

OH

From:

[

mailto: ] On Behalf Of

wslai@...

Sent: Friday, February 08, 2008 11:47 AM

To:

Subject: Patient won't pay bill &

threatens *lawyer*

Dear Group,

I've been a lurking here for about a year. I have a question for the

group about collections and a threatening patient.

First a little background : I'm the spouse of a solo family doctor. I

have a fulltime job, but help out with practice management and IT support

as time permits. We've been open about 2 years. We currently have about 2

FTEs and way too much space, but I'm satisfied with how the practice is

progressing. Our average days in A/R is less than 30. We just started

using a collection agency for outstanding bills > 90 days.

Now here is the situation: a 75 year old medicare patient needed a

physical exam for admittance to assisted living. We advised her that

physicals are not covered by Medicare and got her to sign an ABN. She has

refused to pay. After receiving our discharge/going to collections

letter, she claimed the doctor injured her, which required her going to

the hospital and will need surgery to correct. We believe her injury

claims are bogus. We arranged for her to get an ultrasound at the

hospital to follow up a finding during her physical. We did not cause the

injury. We advised her to follow up if the problem persisted. She never

did. She threatened to call her lawyer.

We decided to go ahead send her to collections. This may have been

unwise, but we were tired of patients threatening *lawyer* anytime they

didn't want to pay a bill. Now that she's in collections, her lawyer

contacted us. He asked if we would forgive the debt and " everything

will go away " . In the meantime, she also sent a letter to the state

medical board claiming incompetence.

So the question: What do we do now? We don't believe there's any case for

malpractice. With the stress, time, and resources involved we're willing

to forgive the debt if we could truly make this go away. But can we truly

make it go away? What's the guarantee that she'll never sue? If we make a

formal agreement (forgive debt = won't sue), that seems like an admission

of wrong doing on our part.

Our next step may be to contact our malpractice insurer. Before we expend

that time and possibly money on lawyers, anyone have sage advice on this

situation or how to handle similar situations in the future?

Thanks in advance.

February 8, 2008

life is too short, write it off and move on.

Brent

>

> Dear Group,

>

> I've been a lurking here for about a year. I have a question for

the group about collections and a threatening patient.

>

> First a little background : I'm the spouse of a solo family

doctor. I have a fulltime job, but help out with practice management

and IT support as time permits. We've been open about 2 years. We

currently have about 2 FTEs and way too much space, but I'm satisfied

with how the practice is progressing. Our average days in A/R is

less than 30. We just started using a collection agency for

outstanding bills > 90 days.

>

> Now here is the situation: a 75 year old medicare patient needed a

physical exam for admittance to assisted living. We advised her that

physicals are not covered by Medicare and got her to sign an ABN.

She has refused to pay. After receiving our discharge/going to

collections letter, she claimed the doctor injured her, which

required her going to the hospital and will need surgery to correct.

We believe her injury claims are bogus. We arranged for her to get

an ultrasound at the hospital to follow up a finding during her

physical. We did not cause the injury. We advised her to follow up

if the problem persisted. She never did. She threatened to call her

lawyer.

>

> We decided to go ahead send her to collections. This may have been

unwise, but we were tired of patients threatening *lawyer* anytime

they didn't want to pay a bill. Now that she's in collections, her

lawyer contacted us. He asked if we would forgive the debt

and " everything will go away " . In the meantime, she also sent a

letter to the state medical board claiming incompetence.

>

> So the question: What do we do now? We don't believe there's any

case for malpractice. With the stress, time, and resources involved

we're willing to forgive the debt if we could truly make this go

away. But can we truly make it go away? What's the guarantee that

she'll never sue? If we make a formal agreement (forgive debt =

won't sue), that seems like an admission of wrong doing on our part.

>

> Our next step may be to contact our malpractice insurer. Before we

expend that time and possibly money on lawyers, anyone have sage

advice on this situation or how to handle similar situations in the

future?

>

> Thanks in advance.

>

February 9, 2008

Wow, what a horrible situation. The only

advice I have is echoing the recommendation of contacting your malpractice

lawyer. I find it interesting she’ll supposedly pay her lawyer, but

not her doctor. How sad.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of wslai@...

Sent: Friday, February 08, 2008

9:47 AM

To:

Subject:

Patient won't pay bill & threatens *lawyer*

Dear Group,

I've been a lurking here for about a year. I have a question for the group

about collections and a threatening patient.

First a little background : I'm the spouse of a solo family doctor. I have a

fulltime job, but help out with practice management and IT support as time

permits. We've been open about 2 years. We currently have about 2 FTEs and way

too much space, but I'm satisfied with how the practice is progressing. Our

average days in A/R is less than 30. We just started using a collection agency

for outstanding bills > 90 days.

Now here is the situation: a 75 year old medicare patient needed a physical

exam for admittance to assisted living. We advised her that physicals are not

covered by Medicare and got her to sign an ABN. She has refused to pay. After

receiving our discharge/going to collections letter, she claimed the doctor

injured her, which required her going to the hospital and will need surgery to

correct. We believe her injury claims are bogus. We arranged for her to get an

ultrasound at the hospital to follow up a finding during her physical. We did

not cause the injury. We advised her to follow up if the problem persisted. She

never did. She threatened to call her lawyer.

We decided to go ahead send her to collections. This may have been unwise, but

we were tired of patients threatening *lawyer* anytime they didn't want to pay

a bill. Now that she's in collections, her lawyer contacted us. He asked if we

would forgive the debt and " everything will go away " . In the

meantime, she also sent a letter to the state medical board claiming

incompetence.

So the question: What do we do now? We don't believe there's any case for

malpractice. With the stress, time, and resources involved we're willing to

forgive the debt if we could truly make this go away. But can we truly make it

go away? What's the guarantee that she'll never sue? If we make a formal

agreement (forgive debt = won't sue), that seems like an admission of wrong

doing on our part.

Our next step may be to contact our malpractice insurer. Before we expend that

time and possibly money on lawyers, anyone have sage advice on this situation

or how to handle similar situations in the future?

Thanks in advance.

February 9, 2008

I'd be cautious about signing anything that remotely admits guilt.

As someone sad -- sad she will pay a lawyer, but not you.

While these are difficult situations, one also has to understand the larger issues.

Had a similar situation with a patient who sued because she felt like we didn't treat her problem adequately.

We got our malpractice lawyer involved -- didn't cost anything - except ultimately higher rates for everyone.

But the lawyer felt we had a good case and fought it to the end and eventually, the patient dropped the case -- or more likely, the lawyer dropped the case because he knew it wasn't a valid case.

An anectdote (which may or may not apply here) -- my dad passed someone down a long hill going into his hometown.

He was 20 and just being a silly college student -- but didn't imperil anyone.

Anyway, the person he passed turned him in.

He had to go to court because they were accusing him of reckless driving -- my dad's dad was the kind of guy who didn't like to make waves and convinced my dad to just plead guilty and get it over with.

So he did.

In hindsight, my dad says he did probably break a law, but was definitely not driving recklessly -- but now he has this reckless driving conviction on his record.

So, if he ever gets in an accident -- there is the possibility of this old conviction coming to light and being used against him - even though it probably wasn't accurate.

While it can be soul sucking to fight these claims -- I would lean toward fighting it a little while.

I imagine 2 things...1. the patient will rack up a bill with the lawyer and eventually drop the suit or 2. the lawyer will drop the case since he is doing it on a percentage of the "winnings", but will realize what a dog of a case it is.

I would definitely talk to your malpractice lawyer and see what advice they give.

I totally understand the issue of making this go away quickly -- but make sure it goes away on your terms.

BTW, at least with my malpractice insurer, COPIC, they even said they are willing to fight these small cases to the end - especially when it's a good case on the doctor's side.

Because if they don't, then the ambulance chasing lawyers come out of the woodwork to ask for $1,000, $5,000, or $10,000 because they know the insurance will just pay up to make these nuisance cases go away -- so they fight them to keep the wolves at bay.

Locke, MD

From: [mailto: ] On Behalf Of EadsSent: Friday, February 08, 2008 5:11 PMTo: Subject: RE: Patient won't pay bill & threatens *lawyer*

Wow, what a horrible situation. The only advice I have is echoing the recommendation of contacting your malpractice lawyer. I find it interesting she’ll supposedly pay her lawyer, but not her doctor. How sad.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O. Box 7275

Woodland Park, CO 80863

www.PinnacleFamilyMedicine.com

From: [mailto: ] On Behalf Of wslai@...Sent: Friday, February 08, 2008 9:47 AMTo: Subject: Patient won't pay bill & threatens *lawyer*

Dear Group,I've been a lurking here for about a year. I have a question for the group about collections and a threatening patient.First a little background : I'm the spouse of a solo family doctor. I have a fulltime job, but help out with practice management and IT support as time permits. We've been open about 2 years. We currently have about 2 FTEs and way too much space, but I'm satisfied with how the practice is progressing. Our average days in A/R is less than 30. We just started using a collection agency for outstanding bills > 90 days.Now here is the situation: a 75 year old medicare patient needed a physical exam for admittance to assisted living. We advised her that physicals are not covered by Medicare and got her to sign an ABN. She has refused to pay. After receiving our discharge/going to collections letter, she claimed the doctor injured her, which required her going to the hospital and will need surgery to correct. We believe her injury claims are bogus. We arranged for her to get an ultrasound at the hospital to follow up a finding during her physical. We did not cause the injury. We advised her to follow up if the problem persisted. She never did. She threatened to call her lawyer.We decided to go ahead send her to collections. This may have been unwise, but we were tired of patients threatening *lawyer* anytime they didn't want to pay a bill. Now that she's in collections, her lawyer contacted us. He asked if we would forgive the debt and "everything will go away". In the meantime, she also sent a letter to the state medical board claiming incompetence.So the question: What do we do now? We don't believe there's any case for malpractice. With the stress, time, and resources involved we're willing to forgive the debt if we could truly make this go away. But can we truly make it go away? What's the guarantee that she'll never sue? If we make a formal agreement (forgive debt = won't sue), that seems like an admission of wrong doing on our part.Our next step may be to contact our malpractice insurer. Before we expend that time and possibly money on lawyers, anyone have sage advice on this situation or how to handle similar situations in the future?Thanks in advance.

February 9, 2008

After sending my original thought - which I stand by -- I've had further

thoughts after reading Brent below.

IF the issue is -- forgive the debt and the patient will not sue, then yes,

make it go away.

BUT, I would get the malpractice lawyer involved and make sure this can't

come back to bite you later.

The agreement should be that the patient won't sue, the debt is forgiven,

and the patient is discharged from the practice...all in writing.

If the patient actually is suing for malpractice -- then I would fight it to

the end.

Locke, MD

Re: Patient won't pay bill & threatens

*lawyer*

life is too short, write it off and move on.

Brent

>

> Dear Group,

>

> I've been a lurking here for about a year. I have a question for

the group about collections and a threatening patient.

>

> First a little background : I'm the spouse of a solo family

doctor. I have a fulltime job, but help out with practice management and IT

support as time permits. We've been open about 2 years. We currently have

about 2 FTEs and way too much space, but I'm satisfied with how the practice

is progressing. Our average days in A/R is less than 30. We just started

using a collection agency for outstanding bills > 90 days.

>

> Now here is the situation: a 75 year old medicare patient needed a

physical exam for admittance to assisted living. We advised her that

physicals are not covered by Medicare and got her to sign an ABN.

She has refused to pay. After receiving our discharge/going to collections

letter, she claimed the doctor injured her, which required her going to the

hospital and will need surgery to correct.

We believe her injury claims are bogus. We arranged for her to get an

ultrasound at the hospital to follow up a finding during her physical. We

did not cause the injury. We advised her to follow up if the problem

persisted. She never did. She threatened to call her lawyer.

>

> We decided to go ahead send her to collections. This may have been

unwise, but we were tired of patients threatening *lawyer* anytime they

didn't want to pay a bill. Now that she's in collections, her lawyer

contacted us. He asked if we would forgive the debt and " everything will go

away " . In the meantime, she also sent a letter to the state medical board

claiming incompetence.

>

> So the question: What do we do now? We don't believe there's any

case for malpractice. With the stress, time, and resources involved we're

willing to forgive the debt if we could truly make this go away. But can we

truly make it go away? What's the guarantee that she'll never sue? If we

make a formal agreement (forgive debt = won't sue), that seems like an

admission of wrong doing on our part.

>

> Our next step may be to contact our malpractice insurer. Before we

expend that time and possibly money on lawyers, anyone have sage advice on

this situation or how to handle similar situations in the future?

>

> Thanks in advance.

>

February 9, 2008

The patient has already written a letter to the state board alleging

incompetence.

>

> After sending my original thought - which I stand by -- I've had further

> thoughts after reading Brent below.

>

> IF the issue is -- forgive the debt and the patient will not sue, then yes,

> make it go away.

>

> BUT, I would get the malpractice lawyer involved and make sure this can't

> come back to bite you later.

> The agreement should be that the patient won't sue, the debt is forgiven,

> and the patient is discharged from the practice...all in writing.

>

> If the patient actually is suing for malpractice -- then I would fight it

> to

> the end.

>

> Locke, MD

--

Graham Chiu

http://www.synapsedirect.com

Synapse-EMR - innovative electronic medical records system

February 9, 2008

The right answer to this particular situation will likely be clear after it is

all over, so since we cannot know the " best " way to handle it, it might be wise

to cover all your bases.

She signed the form accepting responsibility for payment. Your records will

likely not demonstrate any cause for harm to the patient. Hopefully, the contact

you had from her lawyer was in writing. If not, they can say anything they want

to intimidate you to their advantage.

Documenting that conversation in her record as accurately as possible may be

helpful.

I would proactively contact the Board and my malpractice insurer and explain, in

writing, your version of it. I would have my spouse, who is more level-headed

than I, proofread the document before I sent it. The insurance company likes to

know and discuss such matters before they become " official. " The written contact

from her lawyer could also be forwarded to them for their review.

If you have done nothing wrong, then stand still and be patient and insist on

justice. Follow the guidance of your insurer who is paid to protect you, and

remind the Board that you appreciate their attention to you commitment to

provide the best care to your patients.

Lastly, remember the Chines saying, " Sit and meditate by the riverside, and

eventually you will see your enemies will float by. "

Charlie Vargas

New Mountain Medicine

lin, NC

From:

[mailto: ] On Behalf Of wslai@...

Sent: Friday, February 08, 20089:47 AM

To:

Subject: Patient won't pay bill & threatens *lawyer*

Dear Group,

I've been a lurking here for about a year. I have a question for the groupabout

collections and a threatening patient.

First a little background : I'm the spouse of a solo family doctor. I have

afulltime job, but help out with practice management and IT support as

timepermits. We've been open about 2 years. We currently have about 2 FTEs and

waytoo much space, but I'm satisfied with how the practice is progressing.

Ouraverage days in A/R is less than 30. We just started using a collection

agencyfor outstanding bills > 90 days.

Now here is the situation: a 75 year old medicare patient needed a physicalexam

for admittance to assisted living. We advised her that physicals are notcovered

by Medicare and got her to sign an ABN. She has refused to pay. Afterreceiving

our discharge/going to collections letter, she claimed the doctorinjured her,

which required her going to the hospital and will need surgery tocorrect. We

believe her injury claims are bogus. We arranged for her to get anultrasound at

the hospital to follow up a finding during her physical. We didnot cause the

injury. We advised her to follow up if the problem persisted. Shenever did. She

threatened to call her lawyer.

We decided to go ahead send her to collections. This may have been unwise, butwe

were tired of patients threatening *lawyer* anytime they didn't want to paya

bill. Now that she's in collections, her lawyer contacted us. He asked if

wewould forgive the debt and " everything will go away " . In themeantime, she also

sent a letter to the state medical board claimingincompetence.

So the question: What do we do now? We don't believe there's any case

formalpractice. With the stress, time, and resources involved we're willing

toforgive the debt if we could truly make this go away. But can we truly make

itgo away? What's the guarantee that she'll never sue? If we make a

formalagreement (forgive debt = won't sue), that seems like an admission of

wrongdoing on our part.

Our next step may be to contact our malpractice insurer. Before we expend

thattime and possibly money on lawyers, anyone have sage advice on this

situationor how to handle similar situations in the future?

Thanks in advance.

February 9, 2008

I have been threatened with lawsuits several times. The first time, and the most unbelievable was related to an incident that occurred my very first night on my OB rotation as a first year FP resident. An Afghani woman came in who had had no prior births, but had had a prior D & C (for bleeding) years ago. the fetal heart tracing was reassuring until she became completely dilated and began pushing At that time there was a dramatic and prolonged deceleration, the baby's head moved high in the pelvis, and the woman was immediately rushed off for a stat C/S. She had a large uterine rupture and ended up having to have a cesarean/hysterectomy due to the amount of bleeding she was having. The baby girl had a very rocky start, but ended up doing well. The father threatened us with a lawsuit since we had done a hysterectomy and his wife could not have any sons for him. I believe he could not find a lawyer to take his

case.The most recent time I had to call my malpractice carrier was when I suspected a local police officer of hitting his teenage daughter. When I called CPS, as I was morally and legally bound to do, he called his lawyer and asked for records. I wasn't sure how to handle the whole thing, so my malpractice carrier helped me out. This occurred at my old big practice, where I left every night at 9:00, and I was actually frightened for my safety as well. One very helpful thing the lawyer told me was to keep a file of all the conversations and legal papers at home, separate from the patient's file. I documented everything that happened and kept it safe and away from my work stuff.Good luck. Hopefully justice will prevail.Kathy Saradarian wrote: You have heard it all before.Â Contact your wifeâ€™s malpractice company first and listen to their advice.Â We once had a not so similar situation where we received a lawyer letter asking for $10,000 to make a situation go away. Situation was that a 45 yo female came in for annual GYN, no menses in 4 months.Â NP we had working for us did exam.Â Patient was obese.Â Sent her for blood work to confirm menopause or not and FSH and LH came back consistent with pregnancy.Â Patient was called and sent to OB.Â HadÂ a ETOP at about 16-18 weeks GA.Â Claim was missed dx caused severe birth defects. We called the malpractice carrier and they had a lawyer write a letter that no, they would not be receiving any money and we never heard anything again. I hope your situation turns out similarly for you. Kathy Saradarian, MD Branchville, NJ www.qualityfamilypractice.com Solo 4/03,

Practicing since 9/90 Practice Partner 5/03 Low staffing From: [mailto: ] On Behalf Of

vargasca1verizon (DOT) net Sent: Saturday, February 09, 2008 10:02 AM To: Subject: RE: Patient won't pay bill & threatens *lawyer* The right answer to this particular situation will likely be clear after it is all over, so since we cannot know the "best" way to handle it, it might be wise to cover all your bases. She signed the form accepting responsibility for payment. Your records will likely not demonstrate any cause for harm to the patient. Hopefully, the contact you had from her lawyer was in writing. If not, they can say anything they want to intimidate you to their advantage. Documenting that conversation in her record as accurately as possible may be helpful. I would

proactively contact the Board and my malpractice insurer and explain, in writing, your version of it. I would have my spouse, who is more level-headed than I, proofread the document before I sent it. The insurance company likes to know and discuss such matters before they become "official." The written contact from her lawyer could also be forwarded to them for their review. If you have done nothing wrong, then stand still and be patient and insist on justice. Follow the guidance of your insurer who is paid to protect you, and remind the Board that you appreciate their attention to you commitment to provide the best care to your patients. Lastly, remember the Chines saying, "Sit and meditate by the riverside, and eventually you will see your enemies will float by." Charlie Vargas New Mountain Medicine lin, NC From:

[mailto: ] On Behalf Of wslaicomcast (DOT) net Sent: Friday, February 08, 20089:47 AM To: Subject: Patient won't pay bill & threatens *lawyer* Dear Group, I've been a lurking here for about a year. I have a question for the groupabout collections and a threatening patient. First a little background : I'm the spouse of a solo family doctor. I have afulltime job, but help out with practice management and IT support as timepermits. We've been open about 2 years. We currently have about 2 FTEs and waytoo much space, but I'm satisfied with how the practice is progressing. Ouraverage days in A/R is less than 30. We just started using a collection agencyfor

outstanding bills > 90 days. Now here is the situation: a 75 year old medicare patient needed a physicalexam for admittance to assisted living. We advised her that physicals are notcovered by Medicare and got her to sign an ABN. She has refused to pay. Afterreceiving our discharge/going to collections letter, she claimed the doctorinjured her, which required her going to the hospital and will need surgery tocorrect. We believe her injury claims are bogus. We arranged for her to get anultrasound at the hospital to follow up a finding during her physical. We didnot cause the injury. We advised her to follow up if the problem persisted. Shenever did. She threatened to call her lawyer. We decided to go ahead send her to collections. This may have been unwise, butwe were tired of patients threatening *lawyer* anytime they didn't want to paya bill. Now that she's in collections, her lawyer contacted us. He asked if wewould forgive the debt and "everything

will go away". In themeantime, she also sent a letter to the state medical board claimingincompetence. So the question: What do we do now? We don't believe there's any case formalpractice. With the stress, time, and resources involved we're willing toforgive the debt if we could truly make this go away. But can we truly make itgo away? What's the guarantee that she'll never sue? If we make a formalagreement (forgive debt = won't sue), that seems like an admission of wrongdoing on our part. Our next step may be to contact our malpractice insurer. Before we expend thattime and possibly money on lawyers, anyone have sage advice on this situationor how to handle similar situations in the future? Thanks in advance.

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February 11, 2008

Contact your malpractice attorney. Stone wall them if you have a solid case. Also, discharge them from the practice. "You never change things by fighting the existing reality. To change something, build a new model that makes the existing model obsolete"- Buckminster Fuller [Practiceimprovemen t1]