The next thing we want to cover. And this is actually a question that we get frequently CSSHP. It's about malpractice or so we get actually, there are two areas of malpractice. You need to look at. The one where we get the most frequent questions is how much malpractice has there been around telehealth? But there's also another sort of issue evolved malpractice and liability that you should be aware of. So a provider has malpractice insurance in case there's a lawsuit. And currently when I'm recording this of 2021, they're actually has not been a lot of telehealth malpractice suits. There have been some, they've mainly centered really around more the provider's ability. Rather than the technology itself, such as, a radiologist, MS read an X ray. And it wasn't because the X ray was flawed or the technology was flawed. But more on the provider sort of capability experience, etc. So those have been sort of the majority of those malpractice cases that exist. And a lot of them have been settled out of court. So I don't have a whole lot of detail about them. But the bit of detail that I do have really centered around provider ability rather than the technology. However, as I said, I'm filming this during 2021, this could change. Because I'm going by what existed basically prior to the Covid pandemic. Where there was not a lot of telehealth use at that time, I would think it would just be a logical. The more you use telehealth, the more likely there are probably going to be more lawsuits filed. Just because the law of averages, you're just using it more. There's a likelihood that those lawsuits might actually increase. So we don't know if there's going to be maybe malpractice cases filed from the Covid error. During that time period where there was an increased utilization of telehealth. But right now as I said as I'm recording this, there hasn't been a lot of cases. Interestingly though there have been some cases where kind of the opposite of what you expect. Has been the center of the case which is, there have been cases of malpractice suits filed because telehealth was not used. So one case that I am familiar with was a involved a stroke patient. And for some of you who don't know when you have a stroke, the quicker that you can address that. And deal with the stroke the better for possible outcomes for the patient because they say time is brain cells. So you want to try to treat them as quickly as possible. One of the great uses of telehealth is in stroke care, especially if you're dealing with blood clots. And you can administer a blood clot busting medication called TPA. But you need a neurologist to do that. So as you can see that's probably complicated in rural regions who may not have a neurologist on staff. So they're using telehealth to have that neurologist come in and do the consultation. And make the judgment of yes you need to administer TPA. And then if you do that quickly enough you have potentially much better outcomes for the patient. Less sort of issues that they may suffer because you've addressed the issue quickly. Now the suit that was filed was involved a stroke patient where they had telehealth in place. And they could have used telehealth but they decided to transport that patient. So that meant transporting them for several hours in delay potentially. Care that could have provided better outcomes from the patient in the end. So that was a suit that was filed saying that we're filing the suit from this malpractice suit because telehealth wasn't used. So it can go both ways. It could be telehealth issues in a malpractice suit was filed, telehealth wasn't used. And there was probably adverse outcomes on the patient. And where telehealth may have prevented that or mitigated that. And then the students filed that way, that case was also settled out of court. So I don't know exactly the final details on that but that was the crux of the case. The reason for filing it and the basically the issue that the plaintiff brought up. Now, the other thing around malpractice that I don't think it's sometimes really readily apparent to a lot of providers. Is liability insurance and state requirements themselves? So we're talking about malpractice and being having a malpractice suit filed against you. That's sort of in the forefront of everybody's mind. The thing is that providers have liability insurance, malpractice insurance. It may not cover telehealth delivered services because maybe the carrier hadn't anticipated telehealth being used. And their coverage doesn't extend to those telehealth delivered services. So we always recommend to providers that CC with CCP. We say, just check with your carrier to make sure your malpractice coverage will cover those telehealth delivered services. Because not all of them do. I think at this point now, probably the majority of carriers do cover that. But just, it's always good to double check, especially if you're new to telehealth. The other thing is if you are operating in other states, you're trying to provide services in other states. Your malpractice coverage may not cover those sources that you're providing in other states. Because maybe your insurance doesn't actually work in that state. So, check that as well with your care saying, hey, I'm a California provider, I'm starting telehealth. I'll check with my carriage to see if it will cover telehealth deliver services. But I also want to check with them and say, but I know I'm going to be providing services to patients in New York. Is my malpractice services going to malpractice coverage, going to work. And cover those services that I provide to patients in New York as well. Because a lot of times they will decide that the jurisdiction is where the patient is in. So you would be sort of under the New York laws and the New York jurisdiction there. So just double check with your carrier is to make sure your coverage does extend to other States. If you are intending to provide services to other States. Other requirements, this is a little bit sort of a catch all of other things. Just to be aware of that states may have and these may actually be laws or regulations. That may not be readily apparent to you because they don't have anything to do with health care perhaps. But there they will impact you because you're using telehealth deliver services. So what are some of these things? One that is related to telehealth and currently, of as of 2021 only two states have this. In Alaska and New Jersey, if you are providing services via telehealth into that state. You have to register whether telehealth registry. So they did set up the state to set up a registry. And they're saying businesses that are providing services via telehealth into our States. You need to register with us. So just be aware of that as I said, it's only in two states right now, Alaska, New Jersey as a 2021. But you never know other states may decide to do that, recording a telehealth visit. So there are some states that may have in their laws or in their state Medicaid programs. Where they actually prohibit that, where they say, you're not able to record a telehealth visit. You shouldn't be recording a telehealth visit. I don't no of, I can't think of anything off hand where it is required that you recorded telehealth visit. Usually most places are just silent on it. But if they say something, there are a couple of states that explicitly say don't do it. You're not supposed to do that. It's really a lot of times in their Medicaid policies. But there have been one or two states that may actually say that in their state laws as well. One other thing that is not related to healthcare or telehealth and providing health services. That you should be aware of are some of the commercial services laws. And these are laws that deal with basically commerce coming into the state. Or services being offered to citizens of that state or residents of that state. And with telehealth that's going to impact you because that's essentially what you're doing. You're offering services into a state. I'll give you an example in California, there's commercial law that says. If you're offering selling goods or services to residents of California through the internet. And you have a website on that website, there needs to be a phone number where you can reach a person during business hours. That is not related to health care at all. But it is going to touch upon you delivering telehealth services to the state of California. Because you are offering those services via the internet to residents of California. So, on your website, you better have a phone number on there where you can reach a live human being during business hours. So, those are just a couple examples that I want to point out to you. Be aware of, states that you're operating in what they may require of you. Specifically tell health and sometimes not specific to telehealth or even health care services. But perhaps to commercial services. So, I hope this is helpful to you, by now you should be a little bit more aware of, what the stark and anti kickback laws are. Have an understanding of how consent works with telehealth. Understanding about, what is out there regarding malpractice and checking with your carrier about malpractice insurance. And what other sort of laws and regulations might touch upon your provision of services via telehealth. That you should be aware of. So I hope you have found this useful and that you enjoyed this presentation. And hopefully we will see you again on another video. Thank you.
