The experts have some legal advice for you, and you are not going to like it. To keep yourself and your practice out of legal hot water, being diligent about your paperwork is paramount, according to three attorneys specializing medical-legal issues and a physician who's also a lawyer. Here is a paperwork-heavy list of common mistakes to avoid and proactive steps to take, if you aim to steer clear of legal problems.

1. Don't guess about employee work status.
Physician groups often forget that they are employers subject to standard employment laws, including discrimination, sexual harassment, and wage and hour issues, says Marta Fernandez, a partner at Jeffer, Mangels, Butler & Marmaro in Los Angeles, who represents management in labor and em_ployment matters. "The most common mistake made by physicians [involves] monetary liabilities arising from the misclassification of employees in their medical practice as exempt [from wage and hour laws], when California law does not recognize them as exempt," Fernandez says. "It's not a matter of title, but it's a matter of job duties. Only certain administrative [staff], executives or professionals are exempt."

2. Spell out employee duties.
Medical liability suits often allege that physician assistants or nurse practitioners did not get the proper supervision, or failed to follow agreements outlining their duties, says Margaret Holm, managing shareholder of Bonne, Bridges, Mueller, O'Keefe & Nichols in Santa Ana, and a specialist in professional liability defense of physicians. "We certainly have plenty of cases involving groups and their nurse practitioners or PAs, and the problems that arise [from] the scope of practice not ever having been clearly delineated," Holm says.

Scope of practice is supposed to be spelled out in either employment contracts or guidelines for supervision. Reviewing such agreements "about once a year is a very good thing to do, and doctors need to sit down and promulgate those guidelines with the PA or the NP," Holm says.

3. Remember your countersigning duty.
For medical charts maintained by a physician assistant, "at least 10 percent of them have to be reviewed every 30 days," Holm says. "The sooner physicians countersign, the better ... but if they don't countersign at all, that's going to be a problem down the line, because there may have been a bunch of stuff going wrong, and they have let things happen to their patient without stepping in and taking care of the problem."

Some physicians feel that mistakes committed by an assistant may not be the doctor's responsibility, but maintaining documentation is the first step in protecting yourself, Holm adds.

4. Check up on your billing accuracy.
"Physicians should periodically follow a claim from beginning to end--or a series of claims, or a day of claims--to make sure that there's accuracy in billing and claims," says Robert Bitonte, MD, JD, a physical medicine and rehabilitation specialist in Orange and secretary of the Los Angeles County Medical Association.

Doctors employed by clinics and other organizations can be held liable for erroneous and actually fraudulent billing, even if they were unaware of its existence, Dr. Bitonte says. "You should check the billing from the service to the review of the claim, as well as the explanation of benefits to make sure that everything matches." Not doing so exposes you to possible fraud and abuse allegations in civil court and even criminal liability charges.

5. In medical board run-ins, get a lawyer early.
"I'm not just saying this because I'm an attorney, but the first common mistake made by doctors when they're dealing with the medical board is that they don't get counsel involved early on," says Raymond McMahon, a specialist in administrative law and medical malpractice at Bonne, Bridges, Mueller, O'Keefe & Nichols in Santa Ana.

When the medical board receives a complaint, a settlement report of $30,000 or more, or a report of peer discipline, it asks the physician for patient medical records, a summary of the patient's care and a CV. Ignoring the medical board letter is a "big mistake," but nearly as bad are uninformed, defensive or angry responses, McMahon says. "Doctors' first, best chance to get out of a case is to do it at the review level with the summary, and you don't want to lose that opportunity," he says.

Lawyers can assert a physician's right to certain complaint information, and they can chart a strategy if the board decides to proceed with an investigation or accusation hearing through the California Office of Administrative Hearings and Appeals. The ultimate medical board sanction is to revoke a physician's license, but "there are some [insurance] companies who can basically terminate their relationship with you based on the filing of an accusation," adds McMahon.

6. Protect your reputation with mundane records.
"When doctors have an adverse outcome in a malpractice case, a large part of the argument comes down to their documentation," McMahon says. Illegible notes are useless in your defense, while notes documenting treatment plans and workaday items can provide context and explain a doctor's reasoning to a reviewer, he says. Additionally, solid notes will help to secure your payment in the event of an audit by Medicare or another entity, he adds.

Informed consent forms may also be important to any malpractice defense--don't skimp on them. "The physician is in a much stronger position if he can show that the patient understood, acknowledged and agreed to [a procedure]," McMahon says. "Believe it or not ... a lot of people will use generic consent forms where you fill in the name of the procedure, and that [list] pretty standard risks. You're better off having focused informed consents, particularly in elective procedures."