 has 20 years of legal experience focused exclusively on asset protection, risk management and wealth preservation. He helps protect a national client base with more than $6 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians, a Physicians Practice contributor for over a decade and a frequent national CME presenter. Learn more at 

Ike Devji, JD

We examine key asset protection and risk management issues medical practice leaders should address in 2023 to ensure a safe and profitable year.

Our last discussion covered a sample of the predictable and manageable 

personal risks every doctor should address

. This week, look at some of the most common risks to your practice and how to manage them.

We often find that even well advised medical practices run into trouble when their key legal documents are missing or outdated. Make sure you have the following, that they are updated 

and that you actually know where they are

. A missing document often means the courts decide what should have been, rather than the actual intent and agreement of the parties.

Corporate formation documents for your practice including corporate recording documents, operating agreements and 

Employment agreements, contracts and employment policy manuals.

Contracts with vendors and other third parties

Manage employment law risk in three steps

Employment disputes are a serious exposure for medical practices. The average physician will statistically face two med-mal claims during their practice life but the average American business owner is five times more likely to be sued over an employment law issue than for any other reason, and the numbers are big. The average sexual harassment lawsuit, as one example, produces a verdict of over $500K and easily costs another six figures to litigate.You can manage this risk with a three-pronged approach.

First, have strong leadership and a culture of respect and compliance. Employees should know what kind of office you are running and what acceptable professional standards of conduct look like even before they get your employment policy manual. This means accountability, leading by example and correcting or removing those that fail to meet your standards, including front office staff, medical professionals and even providers and partners in your practice who play fast and loose with current standards and sensitivities.

Second, have a written, professionally drafted, state specific employment manual that both outlines your workplace polices and standards and which provides employees a meaningful and specific means of redress in a addressing any issues or conflicts before they become lawsuits.

Third, be heavily insured with both workers comp coverage and Employment Practices Liability Insurance (EPLI) that can cover both the costs of defense and potentially even judgment itself, if the first two layers’ fail for any reason.

Have a liability insurance “system”, not just a “policy”

Insurance works best as a system of layers that are designed to address specific threats. The most obvious policies are your medical malpractice policy and general business liability insurance that covers non-patient exposures on your property (like a slip and fall) at seven figure limits.

Beyond that, most medical practices need all of the following as well, at high limits. It’s also vital to be an 

, which often means relying on an experienced, independent multi-line commercial insurance broker that has access to every policy from the entire market, not just one company they are captive to, as I advise my own clients to work with. A good agent will not only be able to find you the best coverage but will explain the differences between policies and how your coverage and protection may affected by issues like “shared limits” and “consent to settle” clauses.

Here is a sample of some of the high limit commercial insurance coverage I advise my clients consider having in place at seven figure limits.

EPLI (Employment Practices Liability Insurance) for employment law issues.

Data Brach and Cyber Liability Insurance to cover HIPAA/data breaches, ransom ware attacks, internet defamation claims etc.

Workers Comp to cover workplace injuries.

High limits of general liability insurance.

 to cover your business liability as a practice owner, executive or manager.

Disability Overhead Insurance to keep the lights on if you are sick or injured and can’t bill for services.

Key Person disability insurance in case a key member of your practice can’t perform their vital tasks.

 to protect your staff, patients and practice from the growing threat of violence in healthcare settings.

Business Insurance to cover issues like fraud, theft, business interruption and other operational risks.

This list isn’t fact specific to you, get professional help.

has 20 years of legal experience focused exclusively on asset protection, risk management and wealth preservation. He helps protect a national client base with more than $6 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians, a Physicians Practice contributor for over a decade and a frequent national CME presenter. Learn more at 

Articles

Look at some of the most common risks to your practice and how to manage them.

2023 Medical practice asset protection resolutions 

We start 2023 with some asset protection and risk management resolutions for physicians and medical practice owners that will help make your success more predictable.

1.	Resolve to get or update an estate plan (yes, even if you are single).

A good basic estate plan will address the disposition or your estate after your passing with a minimum amount of stress, expense and delay for those you leave behind. It will also protect you during your life by designating legal authority to the person of your choice if your circumstances ever require help making legal or financial decisions. Failure to do may result in strangers making those decisions on your behalf or significant delays and expensive legal process in settling your affairs.

2.	Resolve to invest in personal insurance in the following key areas:

-	High limit personal liability umbrella insurance on your home and cars, $2 million is the bare minimum I now recommend to everyone, and more if you are high net worth.

-	High limit loss coverage that adequately covers the current actual value of your home and its contents. Carefully consider high limit coverage for flooding and damage related extreme weather events.

-	Consider life insurance in an amount both adequate to pay off any debt you want covered for your family in the event of your death (and the loss of your income, like a mortgage, and those who may have guaranteed student debt for you or covered educational costs with an expectation of repayment) and to produce income adequate to support them. Single physicians without children, consider if there are those you need to cover including domestic partners, parents and extended family members you planned to support.

-	Obtain true “own occupation” disability insurance in an amount as close as possible to your actual income and that completely covers your fixed personal overhead as a bare minimum.

3.	Resolve to check and protect your credit.

We should all be doing this (at least) annually to identify any fraud or errors and to be sure that no unauthorized credit or accounts have been obtained using your iden¬tity. This fraud is most common at the end of every year, during the holidays, when new accounts are commonly opened, and consumers make more purchases than usual. This transaction volume provides good camouflage for scammers who can slip charges in among your legitimate purchases and take advantage of delayed billing and other new account promotions.

4.	Resolve to improve your online security and protect your identity.

-	Change your passwords, store them securely, and set up two-factor authentication on all your online accounts.

-	Don’t use the same password at more than one website

-	Don’t store passwords on your desktop in a document marked “passwords”

-	Consider a secure password storage service

-	Don’t use passwords with your own name or that end in “22” or “23”

-	Buy and regularly use a home shredder

A lot of ID theft still happens the old-fashioned way, when mail or trash is stolen and information including account numbers and other personal identifying information on yourself or of 3rd parties you have a legal duty to protect, falls into the wrong hands. The FTC has a simple guide to help identify what you need to keep and what you should securely shred. For other tips on preventing identity theft, visit: https://www.identitytheft.gov/#/.

5.	Secure personal electronics like laptops, smart¬phones, smartwatches and iPads with passwords, biometrics and location services (like “find my iphone”). They should not be unlocked and accessible to others. Millions of Americans get new devices over the holidays due to upgrades in technology and financial incentives. Both personal and business usage of these devices has greatly increased due to remote working scenarios and the fact that trade-in programs are more common than ever, especially for Apple users. Given the amount of sensitive personal and financial data they contain, it’s important you and all your family members (are you sharing any accounts?) think and act carefully about security and properly deleting your information before trading them in, gifting them or otherwise disposing of them.

6.	Plan to protect your assets, literally. Meet with a professional and examine the steps you can legally take to separate the wealth you currently hold from your personal and professional liability, while you still can legally do so.

Next time, we cover the basic business resolution list.


has 20 years of legal experience focused exclusively on asset protection, risk management and wealth preservation. He helps protect a national client base with more than $6 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians, a Physicians Practice contributor for over a decade and a frequent national CME presenter. Learn more at

2023 Asset protection resolutions 

Editor’s note: In celebration of another successful year, Physicians Practice is re-running the five most-read stories in 2022. We wish you a happy holiday season, and we’ll see you in 2023.

Physicians plan and insure against the possibility of a medical malpractice suit. However, they often overlook another serious threat to their livelihood: a medical board complaint. Here are some common causes of complaints and the risks and process involved. 

While most doctors are primarily concerned about a medical malpractice suit, a medical board complaint on its own can significantly disrupt your income - and even end a career. It is vital to have the right coverage at the right limits before a complaint is filed against you.

Unlike an actual medical malpractice suit, a patient can easily file a board complaint at little or no cost. The 

 (FSMB) provides significant guidance to physicians and medical boards in all 50 states. It also provides some very specific 

 on when, and how, to file complaints against physicians.

Complaints can result in fines, reputational damage, license suspension or limitations and even complete license revocation. So, while the results may not be as devastating as a seven-figure lawsuit judgment against the wealth you have already amassed, it can take away your future ability to earn more. For many physicians, this is their biggest asset.   

A medical board complaint may accompany or precede a more onerous medical malpractice lawsuit. Medical board complaint legal defense costs are not always covered by your medical malpractice insurance. It’s a policy specific question, and I advise physicians to make sure they know, at a minimum, the following important details about their coverage:

If they are actually covered for board complaint defense.

 What the dollar limits of that coverage are. It may be a rider that only covers $50,000, for example.

 If they have stand-alone coverage or if that coverage shares limits with another policy, thereby potentially reducing the coverage available for a resulting medical malpractice claim.

According to the FMSB, medical boards sort and prioritize complaints, fast-tracking adjudication of those complaints that present the possibility of imminent patient harm.  Such claims logically include instances of physicians allegedly engaging in sexual misconduct with patients, deviation from the accepted standard of medical care in a state and practicing under the influence of drugs or alcohol.

Some causes common standard-of care complaints include: 

Failure to diagnose, also a leading cause of medical malpractice claims;

Inappropriately prescribing and monitoring opioids or other controlled substances;

Actionable violations of physician-patient confidentiality;

Inappropriate behavior that interferes with patient care, including interactions with others in the chain of care;

Failure to provide appropriate postoperative care; and

Failure to respond to a call from a hospital to help a patient in a traumatic situation.
		

This can be a long and complex process and often involves legal representation. How long a particular case takes depends on how many of the following steps are required to resolve it. Watch the dates carefully, as you have a specific and limited amount of time to respond.

The complaint is assessed for jurisdiction.

The case is prioritized, and the investigation begins. Any indication of risk to patients may allow the board to immediately suspend or otherwise limit the physician out of concern for patient safety.

The state medical board identifies individuals and intuitions with relevant information. Individuals involved in the case are asked to provide statements. 

The complainant receives formal notification. The physician also receives formal notice of the complaint as well as any record requests.

The board conducts a medical review to determine if a patient’s medical care has been impacted as a result of the complaint. Same specialty experts may be called to comment on the standard of care provided.

The board rules. Minor or inaccurate complaints may be resolved at this level with the board providing sanctions or conditions.  

If not settled by the board ruling, the case is set for an informal hearing. It may be formally settled at this stage. If not, the matter proceeds to a formal hearing.

Cases go to a full hearing for adjudication, similar to a civil lawsuit. There is a formal proceeding, with presentation of evidence and witnesses. The board rules on the evidence presented.

Any disciplinary action imposed by the board is entered into public record. It is then part of the physician’s permanent professional record and is available nationally through the FSMB Physician Data Center. Patients can access this info through their state’s medical board or by accessing 

We’ve covered some basics on the risks, causes of complaints and the resulting complaint process. In our next discussion, an attorney who practices in the area of professional discipline and defends doctors in these proceedings shares some specific tips we hope you never need.

, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians. He is a contributing author to multiple books for physicians and a frequent medical conference speaker and CME presenter. Learn more at 

You protect yourself against medical malpractice, but are you protected against medical board complaints?

Most read 2022: What you need to know about medical board complaints

With all the useful information available on Physicians Practice, it is easy to become overwhelmed.

With this in mind, the tip of the week is a chance to reflect on some of the wisdom found all across the site. In a February 2021 story on how to make winter storm damage insurance claims, Ike Devji, JD writes the following:

“It’s vital that you are adequately insured for both liability and loss, including property damage, contents, and business interruption, among others. Make sure you understand vital policy details like the difference between being covered for replacement cost (the dollar amount needed to replace a damaged item with one of similar kind and quality, 

) and actual cash value (which pays only the amount needed to replace the item at its current market value 

It’s vital that you are adequately insured for both liability and loss, including property damage, contents, and business interruption, among others.

Most polices require you to take reasonable measures to prevent further damage to your property like covering a hole in a roof with temporary shelter, calling 

a qualified and licensed restoration contractor

As is reasonably possible, document the damage to your home and/or office with an inventory of any damaged items you can immediately spot, including personal property in your home, damage to vehicles and medical equipment, fixtures, signage, and office equipment, as well as documenting any appointments that had to be cancelled and other loss of revenue related to the damage.”

 to read the rest of the article and be sure to check back next week for another 

Your weekly dose of wisdom from the Physicians Practice experts.

Practice tip of the week: How to make winter storm damage insurance claims

Taking a Section 179 tax deduction for the cost of a luxury SUV is being widely encouraged by finance influencers on social media. We unpack the myth of the “millionaire SUV tax loophole” and look at why so many doctors and business owners are considering buying new cars before the end of the year.

We provide annual warnings on various tax plans that are marketed to affluent physicians and business owners at the end of every year. In some cases, the 

 and fraudulent and will result in penalty to the taxpayer regardless of who implements it. In other cases, the strategy is legitimate and 

On tax issues, I use two sources, the I.R.S, itself and experienced CPAs and tax lawyers. In this case, I turned to 

, a Scottsdale Arizona CPA with 20 years of corporate and private experience that works with medical practices and business owners, many of whom have inquired about and implemented this strategy as part of their larger tax planning. Essentially, consumers are being told by many sources, including a number of high-profile social media accounts, is the following:

Why do rich people all drive luxury SUVs? Because they write them off! They get it for their business and get to drive Escalades, Land Cruisers, Range Rovers and G-Wagons. And this year you can deduct 100%! Here’s a list of the cars that qualify, go get one!

Sound too good to be true? Here are a few surprising facts:

depreciation of a variety of business equipment

Passenger vehicles that meet a certain weight limit do qualify for significant deductions, including 

Qualified taxpayers can deduct up to the whole price of the vehicle this year using “bonus depreciation”

Some of the benefits are being reduced after this year, so many buyers are taking delivery of new vehicles before December 31, 2022

You may deduct the whole cost of the vehicle, even if you leased or financed it

If that was you need to know, you’d be on your way down to your favorite dealership right now. But as always, there’s fine print you need to be aware to do this right.

Bluntly, you can’t just buy a car for yourself or your spouse and write the entire thing off this year without 50%+ qualifying business usage.

Here’s some of the important fine detail Aarti shared with me, and why 

I wouldn’t touch this strategy without the help of an informed CPA.

“Business owners can deduct ordinary and necessary expenses incurred on vehicles used for trade or business using the 

The actual cost method allows for deductions on depreciation, registration fees, licenses, gas, insurance, oil, repairs, maintenance, etc.

The depreciation deduction, including bonus depreciation, is capped on a standard luxury passenger car, SUV, Truck, and van (

. gross vehicle weight rating (GVWR)) at $19,200 for 2022, and decreases annually thereafter.

SUVs, trucks, vans, and other heavy vehicles (used or new) 

. in GVWR are not subject to the cap above and are eligible for 100% bonus depreciation in 2022 if the vehicle is used over 50% in the business. Heavy vehicles, therefore, continue to be an attractive buy for most business owners.

This 100% bonus depreciation starts phasing out starting 2023.

The deductions need to be prorated for business use if the vehicle is available for personal use.

If the standard mileage method is used, the business owner gets to deduct 58.5 cents a mile for the first half of 2022, and 62.5 cents a mile for the second half of 2022.

She also cautioned that, “Proper recordkeeping is critical to substantiate the deductions claimed. A daily log showing business purpose, beginning, and ending odometer readings is important. Business owners should also have the odometer reading at the start and the end of the year recorded to calculate personal vs. business use miles. There are several apps available to help ease this recordkeeping burden including MileIQ, TripLog, MileNote, Falcon etc.”.

This is not tax advice, consult with a tax professional about your specific facts.

 JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. 

Unpacking the myth of the “millionaire SUV tax loophole.”

The SUV tax loophole: Fact vs. fiction 

As we enter the final weeks of 2022 many of you are examining a variety of tax mitigation 

 about the seasonal abusive tax planning targeting doctors. This week we examine two issues that range from a modest tax deduction to what may be a significant financial windfall. Nothing in this forum is specific tax or legal advice. While this information comes directly from an I.R.S. publication, you should always consult your CPA or tax attorney for advice specific to your facts.

Are charitable travel expenses deductible?

Many physicians and nurses volunteer their time to charitable organizations that provide medical services and those that travel on charitable medical missions may be entitled to deduct certain out of pocket expenses.

To deduct your costs, you must volunteer for a qualified charity. Most groups must apply to the IRS to become qualified. Churches and governments are generally qualified, and don’t have to apply to the IRS. Ask the group about its status before you donate your time and use the I.R.S. 

 on to check an exempt organization’s status.

You may be able to deduct some of your costs including travel if they were necessary while you are away from home. All costs must be:

directly connected with the services, expenses you had only because of the services you gave, and

The types of expenses that you may be able to deduct include:

taxi or other transportation costs between the airport or station and your hotel.

Must have “genuine and substantial duty”

 throughout the whole trip. You can’t deduct expenses if you only have nominal duties or don’t have any duties for significant parts of the trip or if a significant part of the trip involves recreation or vacation.

Value of your time or professional service don’t count

You can’t deduct the value of your time or services that you give to charity. This includes income lost while you serve as an unpaid volunteer for a qualified charity.

ERC credits - What are they and how to choose a provider

The Employee Retention Credit (ERC) program is a government benefit in the form of a tax refund. It was passed 

 with 500 employees or lessthat were either closed due to government order OR that suffered a loss of revenue of 10% of more in any division and that retained employees at the onset of the covid crisis.

ERC funds are delivered in the form of a quarterly tax credit (refund) against the employer's share of certain payroll taxes. The tax credit is 70% of the first $10,000 in wages per employee in each qualifying quarter of 2020 and 2021. That means this credit is worth up to $7,000 per quarter and up to $26,000 per year, for each W2 employee you retained. 

For example, a practice with ten qualifying employees at max $26,000 benefit receives $260,000.

Funds are a discretionary windfall, use any way you wish

Funds are not publicly reported, like PPP funds were

You may be eligible even if you got PPP funds, or didn’t qualify for PPP

Funds are not repaid or forgiven; they are yours if you qualify

Receiving the maximum legal ERC benefit requires a detailed tax filing that discloses what you paid and calculates the ERC funds due using your financial records. As you are personally legally responsible for the accuracy of the filing as a practice owner (or responsible practice executive) I suggest you use a professional like CPA or tax law firm rather than a document preparer. These professionals have professional liability. The best ones I found also offer benefits including:

Audit defense for the filing and the refund they calculate for five years

Detailed analysis of the ERC regulations to maximize your legal credit

Ike Devji, JD, has practiced law exclusively in the areas of asset protection, risk management and wealth preservation for the last 16 years. He helps protect a national client base with more than $5 billion in personal assets, including several thousand physicians

Two time sensitive year-end tax issues for physicians: can charitable travel expenses be deducted and how to safely claim a big ERC tax credit from the I.R.S. 