Protecting Medical Practices from Physicians’ Sanctions

August 10, 2020 | Rivkin Rounds Staff | Employer/Employee | Litigation | Private Insurers

A recent article in Part B News, “How to craft provider contracts that deal with board sanctions — and protect the practice,” discussed how physician practices can protect themselves against instances in which their doctors get sanctioned by the state medical board. Rivkin Radler’s Chris Kutner was quoted in the article.

Chris pointed out that if a physician is placed on probation due to some type of misconduct, there may be a negative impact on the practice’s revenue even if he or she still has a license and remains able to treat patients. He also pointed out that managed care contracts “provide that it’s the practice’s duty to make sure every provider rendering services to members of the managed care organization is fully qualified, credentialed and in good standing. Often, especially in larger practices, they don’t keep tabs on this stuff — they don’t make sure the physician profile is up to date, that they’re current on CME,” and other necessary details. Failure to comply with these requirements could give an insurer an excuse to remove the practice from its panel of providers, since “nowadays, managed care companies are looking to shrink their networks so they have more reimbursement leverage,” Chris cautioned.

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