General Questions

We’ve compiled a list of answers to the most frequently asked questions from our members. They are designed to give you a better understanding of our organization, our services, and other technical information. 

Office Systems

What should I do if am told my scripts were used fraudulently?

The Drug Enforcement Administration, the agency in charge of the enforcement of the Controlled Substances Act and regulations, published a “Pharmacist’s Guide to Prescription Fraud” in 2000, in order to provide guidance to pharmacists who encountered fraudulent prescriptions. The guidance provided that when dealing with controlled substances, and there is a question concerning any aspect of the prescription order, the first step is to call the prescriber for verification or clarification.  Other steps to take if there is a discrepancy are to have the patient provide a plausible reason before the prescription medication is dispensed or to request identification.

If, however, a pharmacist believes that he or she has a forged, altered, or counterfeited prescription, the DEA is clear in its guidance: don’t dispense it; call your local police. Michigan law implicitly expects the same conduct as it requires that pharmacists use “good faith” in prescribing controlled substances and advises that pharmacists follow “nationally accepted professional standards,” like this DEA guidance, in dispensing controlled substances. MCL 333.7333

Further, the DEA advises that if a pharmacist believes that there exists a pattern of prescription abuses, he or she should contact the Michigan Board of Pharmacy or the local DEA office.

This guidance was written specifically for pharmacists, but if a pharmacist does not perform its proper duty of contacting the local police in the event of a forged, altered, or counterfeited prescription, and instead calls the physician practice from which the alleged fraudulent prescription came, the practice should take the recommended step and contact the local police or at least encourage the pharmacist to do so.

The DEA, in its Guide, encouraged local pharmacists and physicians to develop a network, or at least a working relationship, which promotes teamwork and camaraderie. Establishing a simple, consistent process for reporting prescription fraud would be an ideal form of communication between pharmacists and physicians in order to protect the DEA number of prescribing physicians and to ensure that proper reports are filed.

Courtesy of Megan Hard, JD - Smith, Haughey, Rice & Roegge law firm.

Why would a physician want to terminate their doctor-patient relationship?

Physicians usually terminate a doctor-patient relationship because the patient does not need his or her services any longer or the patient’s medical care is better served by someone with greater skill or knowledge. However, there are patients who are uncooperative and will not follow medical advice. They may not keep appointments or are disruptive to the staff.

They may seek inappropriate prescription medications by fraudulent behavior. Every practice has patients who refuse to pay their share of the bill. Sometimes the personalities of the physician and the patient are incompatible to the point that the medical needs of the patient are better served by someone else. Physicians can terminate doctor-patient relationships for any reason, provided they give proper notice or provide for another physician who is willing to accept responsibility for the patient’s medical care. 

From David Karp, Loss Minimizer, The Exchange.

How can physicians discharge a patient from their practice?

The decision to end a doctor-patient relationship should be made by the physician. The physician should send the patient a withdrawal from care letter by certified mail. Both a copy of the letter and returned receipt should be part of the medical record. Should the patient refuse the certified letter, send another letter by regular mail and document the fact that this was done. The withdrawal from care letter should include a statement of the physicians intent to withdraw from care, reason(s) for the decision, recommendation to find another physician by contacting the state or local medical society, be available to treat on an emergency basis for 30 days and offer to send medical records to the new physician by enclosing a release of medical record form.

Sample Letter

Dear ________________:

I find it necessary to inform you that I will no longer be able to serve as your physician. The reason(s) for this decision is (are) [indicate a reason(s) or omit this sentence.]

As you require medical attention in the future, I recommend you promptly find another doctor to care for you. [You require prompt, ongoing medical attention for the following:] Contact the [local or state] medical society for the name of physicians who are accepting new patients.

I will be available to treat you on an emergency basis only until [date, at least 30 days after the date this letter is mailed.] This will give you time to find a new physician. Enclosed is an authorization form that permits me to send your new physician a copy of your medical records. Please complete the form and return it to me.

Sincerely yours,
[Signature]

From David Karp, Loss Minimizer, The Exchange.

How should our office staff effectively handle a patient complaint?

Most staff cringe when they hear a complaint about their physician or their office. However, effectively handling complaints gives you a second chance to have a satisfied patient. In the past, complaint handling was the sole responsibility of the practice manager or the physician. Today all staff should be sensitive to patient complaints and have a role in complaint resolution. Wendy Leebov, Ed, D in Effective Complaint Handling In Healthcare offers ten steps for dealing with a complaint:

Step 1: Listen without interruption.

Step 2: Don’t get defensive.

Step 3: Use a “Sad but Glad” statement.

Step 4: Express empathy.

Step 5: Ask questions to clarify the problem.

Step 6: Find out what the patient wants.

Step 7: Explain what you can and cannot do.

Step 8: Discuss the alternative fully.

Step 9: Take action.

Step 10: Follow up to ensure patient satisfaction.

The practice manager should track complaints. A summary of complaints should be discussed at staff meetings in a way that protects the confidentiality of involved staff members. Effective complaint handling is preventive risk management and will lessen the possibility that a patient will file a claim.

What considerations are necessary when closing a practice?

Click here to access an MPIE toolkit containing risk management guidelines and sample tools related to closing a practice.