Avoiding Liability Bulletin – May 2005

… Here’s a useful and common case example that may save you from a complaint or lawsuit by the patient. A lot of complaints (of various kinds) stem from a dispute over fees. Suppose the patient is somewhat behind in his payments and that he owes you $750.00. He now demands, in writing, pursuant to the applicable law in your state (or HIPAA, if you are a “covered provider”), a copy of his records. My advice is usually as follows: “You should comply with the request (or resist, as may be allowed by law and as the circumstances warrant) in a timely fashion, and in the process, mention nothing to the patient about the amount owing and certainly don’t condition your compliance upon receipt of payment (partial or otherwise).” Treat them as two unrelated matters. Ethical standards typically address this issue in a similar fashion, as do some state laws.

… Another scenario involving fees that often leads to problems is where the amount owed, as it rises substantially, creates a debtor-creditor relationship, which, together with the therapist-patient relationship, may arguably constitute an unethical dual relationship. Why did the therapist allow the unpaid balance to rise so dramatically, putting financial pressure on the patient? Why didn’t the therapist refer to a low cost clinic? Why did the therapist exploit the patient financially and make her a debtor of the therapist? I once received a call from a therapist who said, “I need a good collections attorney. Can you refer me to one?” I asked her how much the patient owed her and she told me $20,000.00. I said: “In my opinion, you don’t need a collections attorney, you need a malpractice attorney.” We then chatted for a while!

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Richard Leslie

Richard S. Leslie is an attorney and acknowledged expert on the interrelationship between law and the practice of marriage and family therapy and psychotherapy. Most recently, he was a consultant to the American Association for Marriage and Family Therapy (AAMFT) and has written articles regarding legal and ethical issues for their Family Therapy Magazine. Prior to his work with AAMFT, Richard was Legal Counsel to the California Association of Marriage and Family Therapists (CAMFT) for approximately twenty-two years. While there, he also served as their director of Government Relations and tirelessly advocated for due process and fairness for licensees and applicants.

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