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Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.
Treating family members may seem like an easy and convenient option, but it can lead to big problems. Here's why.
For many, the idea of having a relative as a physician is a source of pride. For many more, the idea of having a physician in the family means easy access to prescriptions, free healthcare, and someone to ask, “Does this look infected to you?”
Most physicians have encountered the relative/friend/acquaintance looking for quick care outside of office hours. While many physicians happily (or not!) oblige, there may be consequences to treating these “informal” patients.
Many state laws and licensing bodies require that medical services provided to family members must be in accordance with the same standard of practice as provided to non-family members. This doesn’t mean that family must make an appointment during office hours and wait in the waiting room just like all the other patients. It does mean that the physician assess and evaluate his relative’s condition in a manner similar to a non-related patient.
If a physician would not prescribe an antibiotic for a patient without conducting a physical assessment, the same should apply for a relative. A physician wouldn’t (or shouldn’t) provide services without appropriately documenting such services in a medical record; the same should be done for a relative. Bottom line: the assessment and treatment process for a relative should mirror that of a non-relative.
Relatives can enjoy a few perks. What good is having a physician in the family if one cannot receive house calls, visits outside business hours, immediate appointment, etc. While such “perks” do not pose any significant concerns, there are some courtesies afforded relatives that are more problematic. For instance, what physician wants to charge her relative a $20 copay? Not many do, which leads to routine waivers of such copays and deductibles. Most insurers do not allow the waiver or non-collection of copays and deductibles for any patient, except in limited circumstances.
Additionally, many physicians are surprised to learn that major insurers often exclude medical treatment provided to a physician’s family member from coverage. I recently attended an educational meeting with a client and a large, national insurer. My client had provided medical care to her daughter, billing the insurer for each visit. While there was no question that these services were necessary, appropriate, and provided in a manner consistent with the physician's non-relative patients, the insurer’s provider contract specifically prohibited making payment to the physician for these services. The physician, her office manager, and office biller had no indication that medical care provided by a physician to an immediate family member was even subject to the terms of the provider agreement, let alone a prohibited service.
Another area of concern with respect to treating family members relates to prescription medication, specifically Schedule drugs. A partner at my firm has spent the bulk of his long career defending physicians in professional regulation matters. A significant percentage of his cases over the years have dealt with physicians who prescribed certain pain medications, narcotics, stimulants, and other highly addictive prescriptions to family members. In their defense, the physicians most often claim that their relative had legitimate pain or need for the medication, and that it was prescribed in the same manner and consideration as any other patient.
While that may indeed by true, in almost all cases the state licensing board points to the fact that the physician maintained no or inadequate treatment records, and therefore, could not support such assertions. Even in those instances where a physician did maintain adequate records, authorities were apt to find that the physician’s actions did not meet the standard of care, but simply enabled a drug-seeking relative.
While these prohibitions may seem like yet another unnecessary intrusion into your practice, I always remind my physician clients that there are benefits to these burdens. Not all families remain close and civil at all times, in-laws and spouses may come and go, and even the best people don’t make the best decisions all of the time. For these reasons, limiting the type of treatment you provide, maintaining adequate records, following your insurance contracts, and properly evaluating patients will go a long way should you have to defend your treatment decisions.