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3 Steps for Firing a Patient Without Incurring a Lawsuit

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3 Steps for Firing a Patient Without Incurring a Lawsuit

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Patient Dismissal Letter

A patient can terminate the physician-patient relationship at any time and is always free to seek another provider.

The physician, however, cannot fire a patient, without risking a patient abandonment complaint.

When the time comes to terminate the relationship, take these actions to terminate patients in a smooth legally-free manner.

Provide a Patient Dismissal Letter

Keep in mind that firing a patient can result in patient complaints, civil liability/medical malpractice claims and medical board actions, so notification should take place in a professional, well-documented manner.

  • Counsel the patient about the issue. Document this counseling in the patient chart. It’s always a good plan to have a witness.
  • Give the patient written notice in enough time.
  • Keep the notice letter simple.
  • Offer alternatives for the patient as well as your services to transfer or copy records.

BONUS: Receive a sample Patient Dismissal Letter when you register for the online medical training from healthcare attorney and educator, Heidi Kocher, BS, MBA, JD, CHC. Heidi gives you the protection strategies you must employ to avoid being accused of patient abandonment when you end a relationship.

Implement a Patient Termination Policy

Having a procedure in place will make firing a patient go more smoothly. As you prepare to draft and implement a patient termination policy, follow these tips:

  • Develop and implement a standard patient termination policy. Outline when you will terminate the relationship. Evaluate each patient on case-by-case basis, considering each patient situation and care needed, and describe the steps you will take for your notice letter, time periods, emergency treatments, continuity of care, referrals, and records.
  • Protect yourself. Make sure you know your state laws on patient records, patient termination, and patient abandonment. Also, review your malpractice insurance to see that your limits are enough and to find out when and how coverage is triggered.
  • Know your payer contracts. They may have restrictions, limitations on when you can terminate patients and required notification periods
  • Follow up via mail. Send a written notification to the patient, by certified mail, then send a second letter at end of notification period, confirming termination of the relationship. Be sure to allow extra time for mailing!
  • Document, document, document. Make sure you document all interactions with the patient, including phone calls, emails, the mailing of the letter and the termination in the patient’s chart.
  • Keep your cool. Don’t engage in a war of words with the patient directly or on social media, and don’t let anger or emotion take over.
  • Provide continuity of care. After sending the termination letter and during the transition period, be sure to still provide prescription refills, labs and diagnostics, and emergency care for the patient. Also, be sure to send the patient’s records to the new provider promptly — don’t hold onto records for an unpaid balance!
  • Train your staff. Be sure your staff knows about the termination, so they don’t set a new appointment after the expired time.
  • Seek legal counsel. Consult an attorney and malpractice insurer before terminating a pregnant patient or patient in a protected class to ensure that you are not terminating because the patient is in a protected class.

Think Twice Before Firing a Patient at High Risk

Terminating a physician-patient relationship puts a practice at risk for patient abandonment complaints that can lead to costly legal lawsuits.

The risk is even higher with certain patients and specific medical situations. You should NOT terminate a physician-patient relationship in these situations:

    • During a crisis situation or acute phase of treatment, such as mental health, substance abuse, trauma, pregnancy, or surgery that requires post-operative care
    • When no other physician is available to immediately take over care
    • When the patient requires highly specialized care
    • If the physician is the sole physician in the community or isolated, rural area
    • When the physician is the only provider who accepts Medicare or Medicaid
    • If the patient owes a large balance but otherwise presents no other issues to the practice
    • If the patient has HIV/AIDS or is part of a protected class
    • If the patient is disabled (unless the treatment disability is beyond the provider’s skill or expertise)

Note: If you conclude that you must terminate a patient in one of these categories, contact your state medical association or board, malpractice insurer, and an attorney. You may not be able to avoid an abandonment claim, but you can do your best to minimize the costs and fall-out.


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