Ike Devji, JD

Happy New Year! It’s good to start another year with Physicians Practice readers and to see a light at the end of the tunnel for America after one of the most challenging years in U.S. history. The country owes a profound debt to the healthcare community for its heroic service and courage in the face of not only overwhelming numbers, an unknown virus, and supply shortages, but also unprecedented levels of anti-science and anti-medicine hostility and disinformation.

The beginning of a vaccination program (which is already facing resistance, physical threats, and disinformation from anti-vaxxers) puts this country, its citizens, and our economy on track to recovery and a return to a new normalcy. If we can get most of the country vaccinated by the end of this year, the chances of some semblance of physical, social, political, and economic stability and normalcy by 2022 are 

. Here are some tips for practice owners and leaders to help make sure you make it until then.

The political violence that rocked the country last week potentially threatened every citizen and business in the area, including medical practices, and was not limited to Washington D.C. There were significant events of violence or threats at various state Capitols and protests across half a dozen or more states including Washington, Georgia, Michigan, and Oregon. The risk isn’t over and is considered high through and after the Presidential inauguration, as there are multiple reports of violent protests being planned both at the inauguration itself and at state Capitols around the United States.

I recently covered some basic election violence risk management 

 that you should review if you haven’t already seen it. Protecting your patients, staff and business continuity requires 

 and may range from dealing with simple curfews and road closures to more direct, physical threats, like 

Be legally prepared to separate partners and employees from your practice

If you’ve seen the news in the last 72 hours, you have likely seen footage from all over the country of people who live streamed, tweeted, or otherwise shared their political activities on social media being exposed, arrested, and terminated from their employment. Healthcare workers including physicians, nurses, and paramedics have not been immune to this and have been identified on social media 

 ranging from unsafe pandemic behavior that exposes themselves and their patients to COVID19, to making false statements and reciting ‘Q-Anon’ conspiracy theories, encouraging violence and allegedly even being part of the attack on the capitol building itself, and 

We’ve previously discussed the importance of formal 

 that control what happens when a partner leaves a medical practice due to issues including disability, departure, and 

. Having this crisis management tool in place may become vital to the reputation and solvency of your practice. Similarly, termination of an employee for disqualifying conduct that threatens the reputation, safety, or operation of a medical practice 

 and needs to follow both the law and the internal process outlined in your office 

, a vital business asset protection tool we have covered in detail.

Whether you’re a power user #SoMeDoc or don’t know a Tweet from a TikTok, social media is faster, more necessary and more powerful and more potentially dangerous to your practice than ever before. Make sure you have (and actually review with all staff and partners, the rules apply to 

 that, in conjunction with your employment manual, outlines your policies and the penalties for violating them. The risks you face range from personal and professional reputation damage to significant financial and legal loss. 

Given recent events, make it unquestionably clear that any content attributable to their employment at your practice including images of them in your uniforms, your logo, their ID badges, or that identify your practice should be treated with the highest level of caution.

 They should know that while they have a right to free speech, that right may have consequences that affect their employment.

Stay safe, we continue the discussion in our next installment.

, 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

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As 2021 begins, it presents both familiar risks and new challenges never experienced in the lifetimes of most Americans. We start the year by reviewing key measures to help you to manage and survive both. 

Physicians 2021 Asset Protection Checklist – Part 1 

As COVID-19 the development of multiple Covid-19 vaccines is hurtling forward at unprecedented speed, so are the new legal, security and liability issues physicians and healthcare leaders must be aware of.

With the development of multiple COVID-19 vaccines and their expected rapid distribution, there is finally hope on the horizon for the physical and economic recovery of the United States. While we can see the light at the end of the tunnel, the road ahead is still long and perilous if not approached carefully. Experts predict that the logistical issues and complexities of vaccinating 300 million people including sub-zero storage requirements, supply chain shortages, an overburdened health care system and growing anti-vaxx, anti-science sentiment could mean that a meaningful vaccination program could take well over a year to complete and another year or more to effectively restore consumer confidence and full economic recovery.

Before any of it has even started, we are watching a variety of legal, security and liability issues develop on a daily basis, and we’ll continue to do so as they evolve in the year ahead.

 have issued explicit warnings about how organized crime has created multiple revenue streams using COVID-19. In addition to making sure the vaccine is stored correctly, healthcare facilities may need to protect their supplies from 

 with a level of physical security that goes significantly beyond what is the current medical industry standard, describing the vaccines value on the black market as ‘liquid gold’. Reports also state that related crimes, including the 

, disruption of the supply chain and the use of websites selling sham cures and medical supplies will be used for cybercrimes ranging from identity theft to malware that could compromise data security or even implant ransomware. This means compliance on the sourcing of any drugs and supplies, their custody, storage and distribution will be more important than ever, as will your IT security procedures, and insurance.

As vaccines become available healthcare workers and first responders are slated to be among the first in line for vaccination priority. While it appears that much of the medical community supports this idea, there are still a number of medical professionals all over the country including 

, nurses and administrators who embrace, “alternative science”, some at the 

, and who are opposed to being vaccinated in general or in some cases, simply to the idea of it being mandatory along with up to 35% of the rest of the country.

At this point, the consensus in the legal industry is that employers can mandate that employees be vaccinated as a condition of continued employment. OSHA has previously supported this idea as well, especially when it comes to the immunization of 

healthcare workers in the face of a pandemic

, (as distinct from regular flu season) as the agency did with the Novel H1N1 virus in the past. There are two 

 to this that that require “reasonable accommodation” if they do not create an “undue hardship” on the employer, including both actual religious objections (merely being “anti-vaxx” is not enough) and medical exemptions for legitimate ADA recognized health conditions, but given the potential for physical and economic harm and the effects of the virus to date, many feel this will continue to be enforceable by employers. Other legal expert have raised additional interesting questions as well, including issues like these in a recent 

 article and continuing education presentation:

What will you do if an immunocompromised employee cannot safely report to work if his co-workers are not vaccinated?

If some, but not all, employees are vaccinated, should you continue to require masks for unvaccinated employees? Alternatively, should masks be required for all employees, or perhaps no employees at all?

If employers require or strongly encourage vaccination and an employee suffers some adverse effect, can the employer be held liable for that injury up to and including a worker’s comp claim?

Does that liability increase if the employer selected the specific vaccine, making the choice of one available vaccine over another?

This list isn’t complete and some issues may be rendered moot by 

. Start thinking about these issues and managing the risks they present is now, before they pose threats to the health of your staff and the solvency of your practice.

Legal, security, and liability issues developing on a daily basis. 

Covid-19 Vaccine: Legal and security issues

I start with a note of gratitude to our readers, many of whom have been kind enough to follow this column for a decade and some of whom I’ve had the pleasure of interacting with personally. Special thanks to those of you that have been on the front lines of the COVID-19 crisis this year, your service and sacrifices are certainly among the things all Americans have to be grateful for and that we have hopefully helped support in some small way. – Ike Devji

We’ve covered a variety of risks this year ranging from the most likely and recurring ones like abusive year-end 

. Here are a few more year-end issues to consider

Managing the risks of the office party. Even given current circumstances, many medical offices will still be having holiday parties in some form. This year adds the obvious additional risks of COVID-19 exposure to the long list of predictable and recurring liabilities I have 

 on multiple occasions. Be especially aware of so called “Covid fatigue” and its national prevalence, including among medical professionals, and make sure you plan and manage an event that is safe for them and for you, both 

. While I certainly understand and respect your desire to express your gratitude to staff and partners in very trying times, the usual risks of an office party, combined with the added stress of the season, political tensions and the need for social distancing are leading some employers to think outside the box. Some alternate ideas include gifts, PTO or bonuses in lieu of a party, additional perks or benefits in the office like catered lunches and other pampering touches and even providing additional PPE like air purifiers, which one doctor gave her staff to take home.

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Beware data breach risk when replacing technology.

ID theft and related crimes targeting healthcare organizations are at an all-time high and moving large numbers of employees to remote working conditions has only increased that risk. Given these changes, the number of practices 

replacing obsolete equipment in their offices at year end

 and buying new laptops, phones and tablets for remote workers more appropriately equipped for the “new normal” like telemedicine and Zoom meetings will be a goldmine of equipment that may store 1000s of protected records that hackers may be interested in. Have a disciplined policy and procedure to replace any such equipment and track where and how it was stored and disposed of as well as having heavy limits of data breach and cyber liability insurance in place.

Reevaluate your personal legal planning and

Do you have adult children, parents or other extended family that will be occupying your home or using your cars for an extended period of time due to lockdowns, school closures and other changes that increase your risk? Do you have adequate life insurance in place given the increased Coronavirus related personal safety risks frontline healthcare workers and their families face? Is your legal planning, including both 

 planning in place and adequate for your risks?

Many practice owners leave too much money above a reasonable operating balance in their practices. If your finances allow it, consider “de-risking” some of that excess capital by taking it out of the business and away from its liability to add to your personal savings. Consider increasing your liquidity for any emergencies or opportunities that may arise, you can always loan it back to your practice if required and you may be limited in taking any outsize distribution in the event of a liability at the practice before you do so.

Selling Your Practice: PPP, MAAP, and CARES Act relief fund compliance

Fund qualified plans sooner rather than later.

 If you make recurring fixed contributions to qualified retirement plans late in the year or early next year, considering doing so now to start any vesting period required to avail of statutory creditor protection. For those that make specific dollar amount contributions based on the guidance of their CPA, consider making estimated contributions, even partial ones, now, to avoid any superseding event preventing the funding of your plan.

As we head into the Thanksgiving 2020 holiday, keep these details in mind to help bring a stressful year to a peaceful and predictable close. 

Five year-end asset protection issues

Physicians are engaging in a wide variety of estate and asset protection planning right now due to risks that include COVID-19; the economy; and various social, legal, and political variables. Unfortunately, not all of the strategies are equally legitimate or effective, and many doctors are still making these common mistakes.

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under blue skies, while you do not have an existing claim, is the single biggest and most common asset protection and estate planning mistake doctors make.

Failing to know and manage all your risks, not just malpractice.

 Doctors are naturally concerned about professional liability and you should be but considering that your only significant risk can be financially fatal. I’ve previously provided both a 

 Many exposures are based on a failure of leadership, management or compliance. The best way to avoid a lawsuit or any other exposure is to manage behaviors that create risk by yourself or others, so you never have a problem to begin with.

Failing to adequately insure personal risks.

 I routinely speak to physicians that are 

 related to their homes, cars, real estate investments, and other non-practice risks. Many of them contact me after an exposure, when options to protect their assets are limited, less predictable, and in some cases 

Failing to adequately insure business risks.

 Medical practices require specific, high limit 

 that goes far beyond their medical malpractice and general liability. This coverage protects you against employment liability, data breaches, managerial malpractice and a variety of other business risks.

 Insurance is a vital line of defense, but will always be 

limited in the scope of what it covers and excludes

 and the dollar limit to which it can be covered. Assume there will be a gap in coverage and have a back-up plan that limits your exposure.

 Actively earned income streams are difficult to fully protect but passive income from real estate investments, interests in other businesses, and personally held investments can much more predictable and tied to the eventual control of your estate plan. These income streams should be paid directedly to an entity that is legally distinct from your unrelated personal and professional liability, like a limited partnership, trust, or other appropriate family holding company, not to you personally.

Failing to segregate assets and liabilities.

 Some physicians continue to hold too many assets personally or mix assets that can affect each other in a single holding entity like an LLC (too many eggs in one basket). Common examples include not separating a medical building from the medical practice inside it, 

 with too many pieces of property and mixing safe, passive assets like investment accounts with dangerous ones, like rental properties.

 Assets held personally are available for all your personal and professional liability and may not be linked to the control of your estate plan. Long term assets should be held in 

 legal entity that makes them legally distinct from your personal and professional liability.

 Transfers of assets to relatives like a 

, using “sham” liens recorded without a real exchange of value, and using LLCs as a magic bullet are common examples of strategies that will fail. It can be even worse however, when strategies include 

, fraud and perjury. Not only will those strategies probably fail, they create additional legal Jeopardy.

 during your life. An LLC is a great business tool but typically won’t protect the 

home you live in or your personal vehicles

 because it lacks legitimate business purpose.

This list is a starting point that just touches on some of the most common asset protection mistakes doctors make I’ve seen over the last two decades. Get personalized help from experienced professionals that takes your facts into account.

A starting point of 11 of the most common asset mistakes.