DISCLAIMER
The patient agrees to arrange or have available primary care services or a local hospital emergency room in case of emergencies or complications. You agree this clinic constitutes the equivalent of an urgent care service visit without a contract or agreement for long term care/follow up except by mutual consent. The Arkansas Anxiety Clinic’s terms of treatment and other procedures includes but is not limited to the following statements. State regulations require patients to meet with the Doctor in person(once only) for ID confirmation, and to establish a patient relationship that is included with the telepsych fee without additional expense for the first appointment only.This clinic does not offer on call services. The patient agrees to read the drug manufacturer’s medication FDA prescription information insert via the internet. and agrees to hold the provider blameless for FDA approved treatments.
Notice of Termination of Services for Fraudulent Conduct
WHEREAS, the Healthcare Provider (hereinafter referred to as “Provider”) is committed to delivering healthcare services in compliance with all applicable federal and state laws, including but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended, and its implementing regulations (45 C.F.R. Parts 160 and 164); and
WHEREAS, the Provider maintains a strict policy against fraudulent conduct by patients, including but not limited to the submission of false information, misrepresentation of identity, insurance fraud, or any other deceptive practices intended to obtain services or benefits improperly; and
WHEREAS, such fraudulent conduct undermines the integrity of the healthcare system, violates the trust inherent in the patient-provider relationship, and may result in legal and financial consequences;
NOW, THEREFORE, be it known that:
1. Termination of Services: Any patient found to have engaged in fraudulent conduct, as determined by the Provider in its sole discretion based on reasonable evidence, shall have all healthcare services terminated immediately and indefinitely. This includes, but is not limited to, the cessation of all appointments, treatments, prescriptions, and access to any medical or administrative services provided by the Provider.
2. HIPAA Compliance: In accordance with HIPAA regulations, the Provider shall protect the confidentiality, integrity, and availability of all protected health information (PHI) during the investigation of suspected fraud and any subsequent termination of services. Any disclosures of PHI related to the investigation or termination shall be limited to the minimum necessary as permitted under 45 C.F.R. § 164.502(b) and shall comply with all applicable laws.
3. No Reinstatement Without Approval: Termination of services due to fraudulent conduct shall be indefinite, and reinstatement of services shall not be permitted unless expressly authorized in writing by the Provider’s designated compliance officer or authorized representative, following a thorough review of the circumstances and any remedial actions taken by the patient.
4. Reservation of Rights: The Provider reserves the right to pursue all available legal remedies, including but not limited to reporting fraudulent conduct to appropriate authorities, seeking restitution, or initiating civil or criminal proceedings as permitted by law.
5. Notice to Patient: The patient shall be notified of the termination of services in writing, delivered via certified mail or other verifiable means, to the last known address provided by the patient. Such notice shall include a summary of the reasons for termination, consistent with HIPAA’s minimum necessary standard.
IN WITNESS WHEREOF, this policy is enacted to ensure the integrity of the Provider’s services and compliance with all applicable legal and regulatory requirements, including HIPAA.
Effective Date: This policy shall take effect immediately upon adoption and shall apply to all patients receiving services from the Provider.
