Recommended Actions for Unsolicited Diagnostic Tests

Executive Summary

Physicians should always respond to unsolicited diagnostic tests. When a physician-patient relationship exists, physicians should assume responsibility for the patient’s unsolicited diagnostic test or refer them for further consultation. When a physician-patient relationship does not exist, physicians can either take on the patient or return the unsolicited test to its original sender.

Recommended Actions

• Confirm that a pre-existing physician-patient relationship exists with the patient for whom you received the unsolicited diagnostic test.
• If a physician patient relationship exists, assume responsibility for or refer the patient for interpretation of the test result and a recommended course of action.
• If you choose to accept the patient, contact the patient and assume all the obligations related to the diagnostic test.

What should you do when you receive a test result that you did not order? This situation is becoming more common as patients now have additional options to self-refer for such tests, often without your knowledge. Examples include health fair results, coronary screening tests or hospitalizations without your involvement. Following are guidelines for dealing with unsolicited diagnostic tests and help to mitigate your liability risk.

When a Physician-Patient Relationship Exists

When you receive an unsolicited diagnostic test result, you must first determine if there is a pre-existing physician-patient relationship. Remember that accepting a capitated payment from a health plan on behalf of a patient may establish a physician-patient relationship regardless of whether you’ve actually seen that patient. If it is clear that you and the patient have a physician-patient relationship, then you should assume responsibility or refer the patient for interpretation of the test result and recommended course of action, regardless of whether the patient self-referred for the test.

When No Physician-Patient Relationship Exists

If no relationship exists, you may choose whether to accept the patient into your practice:

• If you accept the patient, first contact the patient and assume all the obligations of the interpretation, monitoring, and follow-up of the diagnostic test.
• If you choose not to enter into a physician-patient relationship, return the original test to its original sender.

Recommended Actions for Unsolicited Diagnostic Tests 

If you return the unsolicited test results to the source, use a statement such as, “This is not a patient in our practice. Please use your data to inform the patient for appropriate physician referral or follow-up.” This action would also be appropriate if you receive tests results in error (i.e. by fax or mail). Calling the sender directly to notify them of the misdirected result has the best chance of getting the information to the patient and the proper provider for appropriate treatment and follow-up. Critical test results may require more diligence to ensure that the information gets to the appropriate source, provider and patient in a timely manner.

Documentation

Although there is no legal duty, in the interest of patient safety there are some steps you should take in returning an unsolicited diagnostic test. You should keep a log that documents the date the test was received, the patient’s name, the action taken in returning the test to the sender and who the sender is. It is recommended that you fax the test information back so you will have documentation that the information was faxed to the appropriate test source and received.

Receiving protected health information for a non-patient inadvertently is considered a HIPAA breach on the part of the sender. It would be appropriate for the sender to request that you destroy the information as part of their HIPAA breach mitigation.

Lessons Learned

• Develop a protocol for returning unsolicited tests to the sender or diagnostic center, informing them that the individual is not a patient in your practice.
• Consider using a messaging or delivery system that tracks when the original sender receives the returned diagnostic tests.
• After returning unsolicited test and documenting the action taken, destroy the information to avoid any risks of HIPAA violation.

Potential Damages

While providers who receive unsolicited diagnostic tests have no legal duty and claims are relatively rare, we recommend that the healthcare organization inform the sender of the discrepancy to prevent patient harm due to delays in diagnosis. Additionally, if a provider does have a physician-patient relationship or chooses to establish a physician-patient relationship but fails to follow up on diagnostic test results, the physician runs the risk of negligence if they cause a delay in diagnosis and subsequent treatment.