Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

If you’re a doctor, you have many relationships. These relationships are defined in contracts. Some of these contracts are scores of pages long.

Doubtless, you’ve read them all.

Kidding.

You have a contractual relationship with your professional liability carrier.

If you take insurance, you are “in-network,” with the relationship defined by a Provider Agreement.

Work at a hospital? That relationship is structured by by-laws, policies/procedures, and assorted rules.

Employed by a group or healthcare system? You likely have an employment agreement.

Licensing? Once the state gives you a license, you have trailing obligations to keep the Board informed. On the most basic level, this includes notifying them of your current work address.

Here’s form language buried well within one long health insurance Provider Agreement…

Provider shall notify Carrier X at least thirty (30) days in advance if there is a change in the business address, telephone number, hours of operation, tax identification number, other billing information or services provided by Provider.

Additionally, Provider shall notify Carrier X immediately in writing upon the occurrence of any of the following events:

1. Provider’s medical staff privileges at any Hospital are denied, suspended, restricted, revoked, or voluntarily relinquished in lieu of disciplinary action;
2. Provider or Provider employee or subcontractor becomes the subject of any disciplinary proceeding before the Medical or a similar agency in any state;
3. Provider or Provider employee or subcontractor is charged with or indicted for, or convicted of, fraud or a felony;
4. The material modification or termination, or reduction in the amount, of the insurance coverage required for participation in Carrier X, or replacement of coverage that is canceled or terminated;
5. Provider learns of any claim or malpractice action or other lawsuit or other action brought against Provider, or Provider employee or subcontractor, or becomes aware of a malpractice judgment or settlement against Provider, or Provider employee or subcontractor. 

Meaning if any crisis happens, the health insurance carrier wants to know. There’s a duty to notify.

What happens if the doctor chooses or forgets to notify?

Hard to say. Arguably, the doctor would be in material breach of the Provider Agreement. That could trigger termination provisions. It could trigger challenges with re-credentialing.

Are health insurance carriers scouring pubic records looking for evidence of new lawsuit filings? I doubt it. However, data is more easily shared today than ever before. What was once buried in file cabinets in the country courthouse can now be found in newspapers and online.

I have long preached this mantra: It’s better to disclose upfront using your own words as the explanation, than to deliver an excuse after the fact, countering someone else’s words.

It’s also easier to craft a spreadsheet cataloging all of your business relationships and notification obligations before there’s a crisis. This includes point of contact and grace periods. A notification obligation can be “immediate.” It could be 30 days. Or you may have no duty to notify.

So, if you’re sued, how much should you disclose? How much can you disclose? Your defense attorney will likely tell you to say almost nothing. You do not want to interfere with his defense of your case. Less is more. Your defense attorney can help you craft a letter. Or your personal attorney can assist. Such disclosure would point to the notification obligation. It would describe the bare bones of what is in the public record. If the case is defensible, you can broadly state the standard of care was followed. And you will keep the entity notified as to the ultimate outcome.

Will the receiving entity want more details? Maybe.

If it’s the Board of Medicine, for example, they may want a lot more detail. And you will generally need to comply. You will have to identify how much of such disclosures will be kept confidential and not be discoverable. Material submitted to a formal peer review body is generally treated as non-discoverable. While this remains the modern-day rule, this is not always the case.

What’s the take-home point?

To state the obvious, getting sued for professional liability is stressful. Most doctors know to timely notify their medical malpractice carrier for guidance and to make sure a lawsuit will be covered. The less obvious point is that other entities interested in your business also want to be timely notified. Getting dinged for failing to notify all interested parties can compound the stress. The time to craft a spreadsheet detailing such notification obligations is before there’s a crisis.

What do you think?

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. We also provide counsel specific to COVID-19. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.