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We’ve compiled a list of answers to the most frequently asked questions from our members. They are designed to give you a better understanding of our organization, our services, and other technical information.
A range of coverage limits are available based on your preferences and needs.
When considering the amount of coverage to purchase, it is helpful to take into account your medical specialty, geographic location, assumption of risk of personal assets in the event that a large claim is filed, and what premiums you feel you can afford.
Medical liability insurance premiums are primarily based on medical specialty, geographic location, coverage form and policy limits. Other factors that could influence premium costs include procedures performed and risk management practices.
Prior acts coverage, more commonly known as “nose” coverage is a supplement to claims-made insurance policies and may be purchased from a new insurance carrier when a physician changes carriers and had claims-made insurance with their previous employer. Prior acts coverage covers incidents that occurred before the beginning of the new insurance policy date but for which no claim has been made.
You can send us an email but please be sure to include your full name, phone/fax number, and policy number, if available.
You can send us an email but please be sure to include your full name, phone/fax number, and policy number, if available.
You can send us an email but please be sure to include your full name, phone/fax number, and policy number, if available.
You can pay your bill over the phone by calling 616.202.2288. You will not be able to pay your bill online at this time.
MPIE is happy to field your web inquiries here, or by phone at 616.202.2288. We will always quickly refer you to the best person to answer your questions.
MPIE
Dept. 4152
P.O. Box 30516
Lansing, MI 48909-8016
MPIE seeks dedicated, energetic, and skilled individuals to join us. We offer a positive work environment, assorted benefits, and the opportunity to be a team contributor. Call us to learn about open opportunities.
MPIE was formed in 1988 by Butterworth Hospital and 200 of its medical staff members, and began operations in October 1988.
Email request to underwriting@mpie.org. Your request will be processed within 1 business day.
Send email to verifications@mpie.org. Requests will be processed within 10 business days.
Contact underwriting at underwriting@mpie.org or call at 616-202-1150
It is imperative that on receipt of anything vaguely resembling claims of wrong doing, whether it is a demand letter or a Notice of Intent (NOI) that you immediately contact MPIE at 616-202-1799 or you may email claimintake@mpie.org. Please be sure to provide MPIE with a copy of all papers you received. You will be advised by MPIE not to discuss this case with anyone else except MPIE staff or your attorney. Under the Michigan Medical Malpractice Tort Reform Act of 1994, the plaintiff must notify the defendant at least 182 days before a lawsuit can be commenced.
Physicians should decline to discuss medical management of patient care with the patient’s attorney (plaintiff attorney) either by phone or an informal meeting. If the plaintiff attorney desires information from a physician not named in a case as a defendant, MPIE will provide legal counsel if necessary and assist you in responding to the plaintiff attorney’s request. Giving an informal interview or phone consultation without representation by legal council could involve you as a defendant in the future. Your discussion of the case has the potential for self-incriminating testimony.
It all depends on who you ask. Some office practices, on the advice of their attorney or practice consultant release only the part of the medical record that was generated in their office during the past two or three years. MPIE on the other hand recommends that the complete medical record, including lab results, x-ray reports, letters, consultations, except legal communication be released. Legal documents, such as legal opinions from your attorney, letters from MPIE, peer review documents should be kept separate from the medical record.
Medical errors need to be disclosed to the patient and family. Not only are there regulatory notification requirements for disclosure, this is the right thing to do. It is in the “how to disclose errors” that physicians need to develop skills. To learn more about the guidelines to this approach, please call us at 616-202-1799.
Medical errors need to be disclosed to the patient and family. Not only are there regulatory notification requirements for disclosure, this is the right thing to do. It is in the “how to disclose errors” that physicians need to develop skills. There are certain guidelines that can help you:
Care must be taken to ensure the record is not altered, as altering a patient’s medical record is a criminal act in the State of Michigan. It also makes it virtually impossible for your attorney to defend your case in a malpractice suit.
A late entry that is dated and signed is permissible if it provided additional factual information and does not have the appearance of being overly defensive.
Do not erase, obliterate, or white out notes. When it is necessary to change or amend notes, place one line through the entry and write “error” over the entry with initials and a date. See your MPIE Physician Office Risk Management Manual for an expanded discussion.
Removing medical records from the office is a risky practice!
This question always concerns me from a risk exposure standpoint for the physician. This concern is based on the follow items:
At times, there are situations when transport of an original medical record is necessary; such as a practice that has more than one location and allows patients to be seen at the either location. The original medical record will need to be available at the location where the patient is to be seen. In this situation, transport of original medical records is necessary and must be moved in a confidential and secure manner. Confidential and secure transport is considered to be in a locked metal case (to avoid fire or water damage in the event of an accident). Either a combination or key lock is acceptable; the practice manager should have a duplicate key or the combination to allow retrieval and replacement of the records back into the office.
While we at MPIE are glad that this is an infrequent question, the fact that it is asked at all does concern us. MPIE discourages the removal of medical records from the practice for the sole purpose of completing documentation and strongly recommend that anytime original medical records are taken from the office that they are transported in a confidential and secure manner.
From a medical malpractice stand point the safest approach is to keep records indefinitely. If you cannot do this, the minimum time to retain records we recommend are:
Adult patient records: Retain records 10 years from the last date of treatment/visit.
Deceased patient records: Retain records for 5 years from the date of death.
Pediatric patient records: Retain these records until the minor reaches 25 years of age.
Obstetric patient’s prenatal records: Who encountered difficulties, keep these records for 21 years from the birth of the child (unless neurologically impaired, see below).
Neurologically impaired adult or infant: Retain indefinitely.
Indefinite retention is recommended for those records where an adverse outcome or patient dissatisfaction occurred.
Both biological parents have the right to their child’s medical record, regardless of custody, unless there is a court order barring the parent from obtaining a copy of the records. The office should retain a copy of any such court order in the child’s medical record. If there is suspicion that the child or custodial parent might be in danger as a result of the release, the release may be withheld until the safety of the custodial parent and child is verified or a court order preventing the release is provided to the office. Neither parent has the right without the minor’s consent to information protected by state statute such as care and treatment related to pregnancy, HIV, STD, substance abuse and mental health, please see state statues for specifics on age requirements and release specifications or contact the MPIE Risk Management Department.
Stepparents, unfortunately, have no rights to consent to treatment or release of information on their stepchildren, unless it is an emergency, in which case treatment is warranted. Only a biological parent, adoptive parent or a guardian appointed by the court can consent. An office may request that the biological parent(s) accompany the minor for the initial visit at which the biological parent may provide in writing their consent for their spouse/stepparent to consent to treatment and information release. It is recommended that the signature of the other biological parent also be obtained to avoid any allegations that the child was treated with out that biological parent’s consent. Verification of signatures and identification may be obtained by visualizing the driver’s licenses and obtaining a photocopy for the child’s record.
In regards to the question of recording complaints in the medical record: it is a best practice and appropriate to record complaints if they are related to care and treatment in the medical record. The medical record is evidence and will be subpoenaed if there is an allegation of negligence (suit/claim) and used in court for both the defense and plaintiff—if there was a complaint in relation to care/treatment it will of course be directly related to the patient’s medical care—and thus should be in the chart.
It should be accompanied by a short note that states no more than that the patient was contacted (by phone, by mail) regarding this concern/complaint in order to investigate and respond. Remember, you do not want to place statements in the chart that indicate that you/your office staff contacted your medical malpractice insurance company or attorney regarding the complaint as these statements are not appropriate in the medical record as it does not pertain to the care and/or treatment of the patient, but rather is business related and inappropriate for the medical record.
Complaints regarding rude staff/environmental (office) issues/operations (wait times) while not related to medical care may become important at some point if you were required to show evidence of behavior that was disruptive or unacceptable (such as use of off color comments or threats)—if you terminated a patient for this type of behavior the chart should reflect a pattern of this abusive/unacceptable behavior and the physician’s steps to address the unacceptable behavior to substantiate the termination, if it was ever challenged.
Complaints about care received from other providers or at the hospital are important as they may be related to care and treatment the patient received. Always be factual and objective when you chart complaints of this nature. Always seek to chart complaints in quotations using as much of the patient’s exact words as possible. For example: Patient states “Dr. Smith didn’t wear plastic gloves when I saw him, that’s why I got this infection.”
Complaints about bills and your actions to investigate/resolve/respond back to the patient are important in light of fraud and abuse issues; again these types of complaints appear to not be appropriate for the medical record as they do not pertain to care and treatment but are more related to the business of the practice. If you have a billing system or separate filing system that could be utilized for billing complaints that should be done. Billing complaints and resolution/response are a must to record due to fraud and abuse investigations and potential sanctions—just not in the medical record.
Under Michigan law, the authority to release a patient’s records succeeds to one of two classes of persons upon the patient’s death. The first is the legal representative of the patient’s estate—generally designated as Executor, Guardian, Administrator, or Trustee. The second is a beneficiary (or heir) of the patient’s estate.
This second group includes next-of-kin and other persons designated as beneficiaries under a will/trust, made by the deceased patient. A surviving spouse normally would qualify as a beneficiary, as well as immediate family members. If there is doubt about who is requesting a copy of medical records, ask for proof. Generally, a photocopy of the deceased patient’s trust or will, and a copy of the requestor’s photo I.D. will suffice.
Practically speaking, physicians will know of a patient’s death and will know the surviving family member(s). However, if the physician has not heard before about the patient’s death, or has never met the purported family member, then requesting proof of both appears to be reasonable and prudent. Under state law, physicians are obligated to take reasonable measures to safeguard the confidentiality of medical records and to disclose protected medical information only to authorized recipients. Generally, death certificates and copies of the deceased patient’s trust or will are readily available. Asking the requesting party to provide them should not present any significant problems or cause undue delay.
An Authorization for Release of Medical Records should be signed by the legal representative or beneficiary on the patient’s signature line. The signer should print both name and status (e.g., Executor of the Estate, Beneficiary) next to his or her signature.
Physician offices insured by MPIE frequently dispense sample medications. Complimentary starter doses have proven to be of benefit for patients, particularly those without adequate financial resources. However, sample medications are not free because when properly monitored, they cost the practice in both physician and staff time. Physician office policies and procedures should address the following issues:
In order for physicians to maintain their 15% premium discount, they need to complete one educational activity in risk management or patient safety topic annually. Physicians may attend MPIE sponsored education or similar education offered by other entities that have prior approval by the MPIE Risk Manager. If you have a program in mind that you think may qualify, please contact Risk Management at risk@mpie.org or 616.202.2288 to ensure the program meets MPIE’s requirements.
MPIE offers frequent webinars that can be used to complete your risk management/patient safety education requirements.
The Drug Enforcement Administration, the agency in charge of the enforcement of the Controlled Substances Act and regulations, published a “Pharmacist’s Guide to Prescription Fraud” in 2000, in order to provide guidance to pharmacists who encountered fraudulent prescriptions. The guidance provided that when dealing with controlled substances, and there is a question concerning any aspect of the prescription order, the first step is to call the prescriber for verification or clarification. Other steps to take if there is a discrepancy are to have the patient provide a plausible reason before the prescription medication is dispensed or to request identification.
If, however, a pharmacist believes that he or she has a forged, altered, or counterfeited prescription, the DEA is clear in its guidance: don’t dispense it; call your local police. Michigan law implicitly expects the same conduct as it requires that pharmacists use “good faith” in prescribing controlled substances and advises that pharmacists follow “nationally accepted professional standards,” like this DEA guidance, in dispensing controlled substances. MCL 333.7333
Further, the DEA advises that if a pharmacist believes that there exists a pattern of prescription abuses, he or she should contact the Michigan Board of Pharmacy or the local DEA office.
This guidance was written specifically for pharmacists, but if a pharmacist does not perform its proper duty of contacting the local police in the event of a forged, altered, or counterfeited prescription, and instead calls the physician practice from which the alleged fraudulent prescription came, the practice should take the recommended step and contact the local police or at least encourage the pharmacist to do so.
The DEA, in its Guide, encouraged local pharmacists and physicians to develop a network, or at least a working relationship, which promotes teamwork and camaraderie. Establishing a simple, consistent process for reporting prescription fraud would be an ideal form of communication between pharmacists and physicians in order to protect the DEA number of prescribing physicians and to ensure that proper reports are filed.
Courtesy of Megan Hard, JD – Smith, Haughey, Rice & Roegge law firm.
Physicians usually terminate a doctor-patient relationship because the patient does not need his or her services any longer or the patient’s medical care is better served by someone with greater skill or knowledge. However, there are patients who are uncooperative and will not follow medical advice. They may not keep appointments or are disruptive to the staff.
They may seek inappropriate prescription medications by fraudulent behavior. Every practice has patients who refuse to pay their share of the bill. Sometimes the personalities of the physician and the patient are incompatible to the point that the medical needs of the patient are better served by someone else. Physicians can terminate doctor-patient relationships for any reason, provided they give proper notice or provide for another physician who is willing to accept responsibility for the patient’s medical care.
From David Karp, Loss Minimizer, The Exchange.
The decision to end a doctor-patient relationship should be made by the physician. The physician should send the patient a withdrawal from care letter by certified mail. Both a copy of the letter and returned receipt should be part of the medical record. Should the patient refuse the certified letter, send another letter by regular mail and document the fact that this was done. The withdrawal from care letter should include a statement of the physicians intent to withdraw from care, reason(s) for the decision, recommendation to find another physician by contacting the state or local medical society, be available to treat on an emergency basis for 30 days and offer to send medical records to the new physician by enclosing a release of medical record form.
Dear ________________:
I find it necessary to inform you that I will no longer be able to serve as your physician. The reason(s) for this decision is (are) [indicate a reason(s) or omit this sentence.]
As you require medical attention in the future, I recommend you promptly find another doctor to care for you. [You require prompt, ongoing medical attention for the following:] Contact the [local or state] medical society for the name of physicians who are accepting new patients.
I will be available to treat you on an emergency basis only until [date, at least 30 days after the date this letter is mailed.] This will give you time to find a new physician. Enclosed is an authorization form that permits me to send your new physician a copy of your medical records. Please complete the form and return it to me.
Sincerely yours,
[Signature]
From David Karp, Loss Minimizer, The Exchange.
Most staff cringe when they hear a complaint about their physician or their office. However, effectively handling complaints gives you a second chance to have a satisfied patient. In the past, complaint handling was the sole responsibility of the practice manager or the physician. Today all staff should be sensitive to patient complaints and have a role in complaint resolution. Wendy Leebov, Ed, D in Effective Complaint Handling In Healthcare offers ten steps for dealing with a complaint:
The practice manager should track complaints. A summary of complaints should be discussed at staff meetings in a way that protects the confidentiality of involved staff members. Effective complaint handling is preventive risk management and will lessen the possibility that a patient will file a claim.
Click here to access an MPIE toolkit containing risk management guidelines and sample tools related to closing a practice.
MPIE provides a manual for our physician and office staff members. We’re continually updating the manual to give you the latest information, so you’ll need to access it here. It isn’t available in print.
MPIE provides telephone consultation for physicians and their office staff. Questions concerning risk management issues and how to respond to legal notices are frequently encountered. If you have a risk management situation or questions that need immediate attention, please contact MPIE at 616.202.2288 or risk@mpie.org.
Legal counsel will be sought at no additional charge to subscribers when additional expertise is required.
Members can view our Resource Library on the Insured Portal.
Subpoena’s are issued for a variety of reasons and in a number of contexts. The most common uses relate to the production of records or the appearance of a witness at a trial or hearing. Only subpoenas with an “authorized signature” by an “attorney of record,” the clerk of the court, or a judge are valid and enforceable. An “authorized signature” can be written by hand, stamped, typed, photographed, or lithographed. The subpoena must be imprinted with the Seal of the Supreme Court of Michigan, provide the case number assigned by the state and the Court’s location, set forth the date, time and place of the hearing and the title of the action, and state that a failure to comply may subject the recipient to penalties for contempt of court. If it contains these elements, it is presumptively valid and must be complied with. If you receive a subpoena that is questionable in any way, please call call 616.202.2288 and request to speak with Risk Management or email risk@mpie.org.
The law requires that the signer of a subpoena provide “reasonable notice” of the date and time of appearance. It must be served “at least 2 days” before the witness is to appear. A failure to comply with the subpoena may be considered contempt of court. The party issuing the subpoena must take “reasonable steps” to keep the witness informed of adjournments or changes in the hearing or trial schedule. If the served witness notifies the party that it is “impossible” for the witness to be in Court as directed, the party must either excuse the witness from attendance at that time or notify the witness that a special hearing may be held to adjudicate the issues. If you are subpoenaed to testify at a trial or a hearing, you are strongly encouraged to contact your practice manager or MPIE Risk Management for assistance with any logistical or substantive concerns.
Health care providers are often asked to provide factual and/or expert testimony in both civil and criminal matters. Attorneys for any party can issue subpoenas requiring a provider to appear at a time and place of their choosing, although it has to be in the county where the witness resides. More often than not someone from the requesting attorney’s office will first contact the provider to set up a mutually agreeable date for a proposed deposition. Testimony sought at these depositions can range from innocuous to significant in many contexts and thus before responding to any request there are several steps which should be considered.
First, understand that if the initial request is ignored, it may well be followed by a subpoena with a date and time over which you have no control. Lesson here—don’t ignore the request—it probably won’t go away.
Two, have your practice manager obtain the name of the action (criminal or civil) and the identity of all parties and their counsel.
Three, contact MPIE Risk Management for assistance with respect to whether the requested testimony may present any potential, professional liability exposure for you or other involved health care providers. Well intentioned but unprepared testimony can (and often does) lead to devastating professional outcomes during a skillful cross by an experienced attorney. As appropriate, we will obtain legal counsel to assist you with any potential issues surrounding your anticipated testimony, and its scope.
A copy of the patient’s medical record should only be released after the physician has reviewed the request. The subpoena must be accompanied by the patient’s signed authorization for release. If the request appears to be related to a legal action against the physician, notify the MPIE Claims Department before releasing the record.
A range of coverage limits are available based on your preferences and needs.
When considering the amount of coverage to purchase, it is helpful to take into account your medical specialty, geographic location, assumption of risk of personal assets in the event that a large claim is filed, and what premiums you feel you can afford.
Medical liability insurance premiums are primarily based on medical specialty, geographic location, coverage form and policy limits. Other factors that could influence premium costs include procedures performed and risk management practices.
Tail coverage is an optional protective measure to extend your claims reporting period. It is available for claims-made policies, and not required for occurrence policies.
Prior acts coverage, more commonly known as “nose” coverage is a supplement to claims-made insurance policies and may be purchased from a new insurance carrier when a physician changes carriers and had claims-made insurance with their previous employer. Prior acts coverage covers incidents that occurred before the beginning of the new insurance policy date but for which no claim has been made.
Premiums are due on a quarterly basis.