Associate dentist liability regarding insurance and medicaid billing in a high volume practice

The most basic rule of tort law is that you are only responsible for that which you do personally and for what your employees do in the scope of their employment. Thus, if you put your name on something as an employee, but your employer alters it fraudulently without your knowledge, you are not responsible for that just because your name is on the item – but of course proving that you didn’t know about any change is not always easy (a good idea is to make a copy of the item before it leaves your hands and you never see it again until the authorities come calling). Where employer fraud is rampant, it sometimes becomes incredible for an employee to reasonably assert he or she was unaware of things in the absence of clear evidence otherwise. You can seek indemnification clauses in an employment contract so that an employer will have to pay for any damages, attorney fees, or civil penalties imposed on you as a result of the employer’s own actions – but few employers would agree to do that even if the employee insisted (who would want to start off on that foot with any employee paranoid over fraud?). Also, nothing can save anyone from government authorities who seek criminal fines or other criminal sanctions for something like Medicaid or insurance fraud. No indemnification or other contractual agreement will be enforced where it seeks to shield someone from criminal behavior. You are already shielded by the law from an employer committing fraud that you were completely unaware of and had no reason to be aware of. All you need to do is make sure that you can establish your unawareness credibly. Making copies of claims you sign is the easiest way. Randomly doing your own review of submitted claims is another way to monitor things. Carefully charting your work in the patient record is another check and even keeping your own separate claims ledger is an idea. Those things make it harder for an employer to take liberties by altering items because the back-up documentation clearly wouldn’t make it easy to argue pretend justifications for the alterations. But, and this is a matter of common sense, if you really think your employer is engaging in that kind of fraud, find another employer as quickly as possible.

Acknowledgement: a very knowledgeable General Counsel friend

Categorised in: Dr. Dorfman Says

This post was written by Dr. Jeffrey Dorfman