Texting Your Patients

We routinely receive requests from physicians and hospitals for information about texting or emailing with patients.

Texting can be an excellent way to remind patients of appointments, for examinations and for tests.  It can also be used to encourage compliance with certain medications.

Emails can be an excellent way to provide organized responses to the chaos of inquiries from patients about setting appointments or for post appointment information.

Since most emails and texts are not encrypted, you will need a written authorization from your patient to allow unencrypted email or texting of any communication that even might have PHI included, such as test results or even the fact of an appointment with a particular specialist.  A sample form of authorization for such emailing and texting is contained on our website (https://www.joneswallace.com/authorization-utilize-emailtext-messaging-communicate-protected-health-information).

Sloppy at Best

AmerisourceBergen has agreed to pay $260 million dollars for distributing misbranded and mishandled drugs.  This payment is to resolve criminal liability.  From 2000 to 2014, AmerisourceBergen prepared millions of syringes that were filled with cancer drugs and shipped them to providers in every state.  AmerisourceBergen transferred the drugs from their original glass vials into individual plastic syringes and, according to court records, did so in an unclean, unsterile environment.  Beyond this, the company sold excess drug products from the vials (overfill) and even combined overfill from multiple vials to pool the drugs even though the vials usually contained a “single-use” only designation.

AmerisourceBergen sought to avoid FDA knowledge by not registering its subsidiary as a re-packager or manufacturer with the agency and instead claimed its subsidiary was a pharmacy regulated by state law.  This attempted to use an FDA registration exemption for pharmacies.  In addition to the $260 million dollars to be paid, AmerisourceBergen is belatedly starting a compliance and ethics program that requires corporate board members to annually review the effectiveness of the company’s compliance program.  There is no indication in the court papers that the personnel and executives who knew of this operation will spend any time in prison.

Medical Practice Embezzlement

All small businesses need to protect themselves against employee theft and embezzlement.  Medical practices may be particularly vulnerable to employee theft due to the focus on patient care and the complexities of billing for and accounting for patient charges.

Best practices:

• Know your employees.  Be careful in hiring them, verify everything on an application.
• Enforce regular work hours and require employees to use vacation days and to take time off.  Employees should not normally need to take work home and employees who refuse to allow anyone else to do their job or to even look at their work are both signs of a problem.
• Know every employee’s job and rotate jobs among employees.  You should know what your normal weekly payroll is and your normal weekly and monthly charges are so you will notice any variations.
• Divide up financial duties.  Do not let one employee control cash, receipts and payments-divide the work up.  Also consider rotating duties from time to time.
• Check your bank statements every month.  Watch for discrepancies or changes in your normal charges, costs and receipts.
• Consider having your outside accountant assist you in designing and periodically testing your internal controls.
• Consider moving all of your billing and receipts functions to a third-party biller and your account to a CPA.  An outside billing company can ensure that your source of funds is under your control and that your employees are only dealing with verifiable and recurring monthly expenses.

This newsletter is edited by Paul Wallace of Jones • Wallace, LLC, a member of the American Bar Association Healthcare Law Section and the American Health Lawyers Association who has been representing physicians and healthcare practices for over 25 years.  Mr. Wallace assists physicians, practices and hospitals in contract items, federal legal compliance, practice entity creation, estate and wealth planning and similar issues.  Please feel free to call if you have any questions on this newsletter or legal matters at (812) 402-1600 or pwallace@joneswallace.com.