Q.: May I treat my own employees?
This is an activity that falls in the “not specifically prohibited” category but is still fraught with pitfalls. In the first place, you have the same duty of care to an employee as you would toward any patient, and you should only perform procedures within your competency. The fact that the individual is your employee does not justify trying a new procedure in which you have no experience. Secondly, consider that if the employee becomes dissatisfied with treatment, it may lead to both a malpractice complaint and employment-related complaints as well.
Additionally, if you opt to treat one employee, your policy should be that you are willing to treat all. Although you are not legally obligated to treat any patient, an employee whom you decline to treat may be more inclined to find some form of discrimination in your refusal. Finally, check the terms of your employee health plan first, because it may not permit you to submit claims for the treatment of your own staff.
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Maintaining Records
If you still decide to treat your employees despite the risks, you must maintain proper records of your treatment. You should process employee claims as any other patient and collect co-payments or appropriate co-insurance from the employees. Health plans may view the failure to collect the patient portion as insurance fraud, because if you never intended to collect the copay, coinsurance or deductible, you are, in effect, reducing the total bill and are therefore collecting 100% of the actual bill rather than collecting only the portion that is covered by insurance.
In addition, if you waive your employees’ co-payments, you may be violating federal anti-kickback law as well as the Illinois Medical Practice Act. Regardless of your good intentions, any of these situations could result in the health plan’s demand for refund, grounds for license discipline or, at worst, prosecution for health care fraud.
Lastly, please review your PPO provider agreements to see if they contain a provision about the treatment of employees. Many health plans do not cover services performed on employees.
