Tuesday, October 22, 2013

Lawyer tricks of the trade: Billable hours

Lawyers are hardworking people. That's for sure. Take this lawyer from Ohio who billed long hours for court-appointed cases. For instance, he billed for 21, 21.5, 23 and 29 hours of work for 4 different days. His lawyer said he did the work but was simply a poor record-keeper.


Not to be outdone, a lawyer from Iowa billed for more than 24 hours of work in a day on 80 separate days. He is being charged with a felony for receiving $178,000 for what are being called improper payments for work as a public defender.

Four other lawyers were terminated from the program for similar issues.

And you thought doctors worked long hours?

The president of the Iowa State Bar Association called the findings of the audit that discovered the problems "an isolated aberration, involving five lawyers. Simply put, a few bad apples do not spoil the barrel."

Are these isolated aberrations?

I'm not so sure. A lawyer friend of mine (yes, I do have friends and even relatives who are lawyers) tells me that this is not particularly uncommon.

He said that lawyers will often schedule 5 or 6 case conferences at a courthouse over a 2-hour period and bill each client for 2 hours worth of work.

At least one lawyer feels that the "billable hour" model should be scrapped because "The billable hour makes no sense, not even for lawyers. If you are successful and win a case early on, you put yourself out of work. If you get bogged down in a land war in Asia, you make more money. That is frankly nuts."

This meshes nicely with a story my lawyer friend told me. Shortly after he became a lawyer, he proudly walked into his boss's office to report that he had settled a case in record time. His boss then chastised him for doing so and pointed out that settling the case so quickly cost the firm a lot of money.

It's too bad that legal services are a "privilege"instead of a  "right." Then maybe someone other than I would be upset about how much it costs.


Unknown said...

Billing by the hour means that one can be caught-out for billing 26 hours in a day. Is that why doctors generally eschew time-based billing? It is too easy to be caught cheating/lying/fudging. It is much harder to catch someone lying for documenting examination findings they never did (but dictated or checked off) and much harder to catch someone lying for inflating the complexity of the medical decision making. When I first learned how evaluation and management coding was done (by counting bullet points) I was in disbelief. I then learned that it was a "wonderful" system that made it so easy to upcode - if you are so inclined. Then software (electronic medical records) came out that made it oh so tempting.

All humans lie. Have your read the "The Honest Truth About Dishonesty" by Dan Ariely.

Skeptical Scalpel said...

Farrel, excellent point. You may be interested in a post I wrote about upcoding last year--http://skepticalscalpel.blogspot.com/2012/12/electronic-medical-records.html

Anonymous said...

The thing is we (doctors) don't like the E&M system. It was forced on us by medicare. I'm sure I bill medicare much more for E&M codes now than I did 10 years ago for the same office visit because the billing people have told me what to say and document in my H&Ps. Most of it is BS. For example for a healthy hernia patient do I really need to examine for mouth lesions, or take a psych hx, or do a fundoscopic exam?

Skeptical Scalpel said...

Anon, so true. I have seen the padding of E&M codes done by many specialties. It is a joke.

Anonymous said...

Yeah, the E&M with electronic systems is a joke. I see multi-page pre-op H&P's from primaries now detailing everything from sexual history to neuro exam - for cataract surgery.

(Cataract surgery, for those who don't know, are modern medical miracles which take less than 10 minutes surgical time under local anesthesia with minimal sedation if the ophthalmologist is within 20 years from residency. The physiological stress is prob. less than having your teeth cleaned and scraped for an hour by your dental hygienist.)

I don't think that doctors are any less greedy than lawyers, except that the latter make much less and have to scramble more.

artiger said...

Why can't lawyers' compensation be based on results? You know, quality measures, value based purchasing, lowering costs, etc?

Skeptical Scalpel said...

Anon, thanks for commenting. I was with you until your last sentence. I'm not sure which profession has more greedy people. It would make a good study.

Artiger, interestingly, plaintiffs' lawyers do get paid based on results. If they lose a malpractice case, they get nothing. And they have invested their own money and time preparing the case.

artiger said...

Yes, plaintiff lawyers do. I meant to refer to the legal industry as a whole.

Anonymous said...

Of course one side-effect of the "contingency fee" system in lawsuits is that lawyers will only agree to take on a case if it has a very good chance of winning. If physicians did this, who would operate on GBMs?

Skeptical Scalpel said...

Anon, excellent point. I can think of many diagnoses that no one would want to operate on.

Patrick Chavoustie said...

I have grown tired of the lack of consistency in regards to legal billing. We now only hire legal work on a flat rate. Many other business work in this fashion, why not lawyers? While I get that many types of projects would not allow lawyers to work on a flat rate as their is no way to predict the amount of hours that will be needed.
Projects such as contracts, employee agreements, articles of business and such can certainly be charged on a flat rate.

Skeptical Scalpel said...

Patrick, I agree that would be a good way to keep costs down. Now that there is a glut of lawyers, this might be easier to do.

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