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Doctors, nurses, and other medical professionals are required to maintain a valid medical license in order to provide treatment to patients. The requirements to obtain a license are extensive, and providers will need to remain in good standing and meet additional requirements when applying for the renewal of their medical license. Medical professionals should also be aware that they could face disciplinary action by the Illinois Medical Board, the Illinois Board of Nursing, or other divisions of the Illinois Department of Financial and Professional Regulation if they are accused of violating laws or professional standards. To avoid discipline that could result in the loss of your medical license, you will want to do the following:

Do not engage in unprofessional or unethical conduct - Medical providers can face discipline for a wide variety of actions that violate ethical standards or are likely to harm patients. These may include gross negligence when providing medical care, making misleading statements about a person’s qualifications or the forms of treatment they are suggesting, promoting certain drugs or medical devices for financial gain, overcharging for services, or engaging in sexual misconduct. By following accepted standards and practices and avoiding inappropriate behavior, you can ensure that you will not be accused of unprofessional conduct.

Do not violate the law - A conviction on felony charges may result in the suspension or revocation of a person’s medical license, even if the offense was unrelated to the practice of medicine. For example, a DUI arrest or conviction may be grounds for license discipline. A provider may also face discipline if they are accused of committing child abuse or neglect, and an investigation by the Illinois Department of Children and Family Services (DCFS) uncovers clear and convincing evidence that abuse or neglect occurred. By following the law while practicing medicine and during your personal time, you can avoid disciplinary action related to criminal charges.

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IL license defense lawyerFor healthcare providers such as doctors, nurses, psychologists, physical therapists, or pharmacists, notification that their practice is being investigated by an Office of Inspector General (OIG) can be very concerning. A state or federal OIG will look into reports of healthcare fraud or forms of waste or mismanagement involving Medicare or Medicaid. Depending on the results of an investigation, a provider may face a number of consequences, including exclusion from these programs or even criminal charges. To avoid these issues, it is crucial for providers to secure representation from an experienced attorney as soon as they are aware of an OIG investigation.

What Is the Office of Inspector General?

Different departments of the federal government and state governments have their own Offices of Inspector General. These offices are tasked with uncovering fraud, waste, or abuse that results in financial losses for government programs. Since Medicare is a federal program, the Office of Inspector General for the federal Department of Health and Human Services will investigate cases related to this program. Medicaid is administered at the state level, so the applicable state Office of Inspector General will usually investigate allegations of fraud or waste involving this program.

What Happens During an OIG Investigation?

In most cases, an OIG will investigate claims that a provider has committed healthcare fraud, which may include:

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IL DEA defense lawyerFor medical providers who prescribe or dispense controlled substances, maintaining a valid DEA registration is a crucial requirement that is necessary to continue providing services to patients. In some cases, these providers may be subject to DEA investigations and enforcement of laws and regulations related to controlled substances. The DEA is aggressive in its efforts to combat the illegal distribution of drugs, and agents will often threaten a provider and state that they could face criminal consequences, but this could be avoided if a person voluntarily surrenders their DEA registration. However, providers should understand that doing so is an irrevocable step that is likely to have a variety of negative effects on their medical license, their practice, and their career.

Consequences of Surrendering Your DEA Registration

Being subject to a DEA investigation can be very intimidating. If a DEA agent presents you with Form 104, “Voluntary Surrender of Controlled Substances Privileges,” and states that if you do not cooperate and turn over your controlled substance registration, you could face criminal prosecution, you may feel that you have no option other than to sign this form. Some DEA agents may even offer reassurances, claiming that agreeing to a voluntary surrender will make things easier for you and that you will be able to reapply for registration in the future.

In reality, voluntarily surrendering your DEA registration will make things easier for the DEA, but it will make things much more difficult for you. If the DEA was to pursue a case against you, they would have to prove that you committed violations such as unlawful prescribing or unlawful dispensing of controlled substances, and you will have the right to defend yourself in a DEA administrative hearing. If you sign Form 104 and turn over your DEA registration, you will be admitting to the DEA’s accusations and giving up your right to a hearing, and the DEA will no longer need to show that you committed any violations.

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IL pharmacy lawyerPharmacies provide a variety of products and services to patients, and they will need to maintain the proper licensing and accreditation to ensure that they can continue operating. Some pharmacies offer products that fall under the category of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS), and to receive payments through Medicare for these products, they will be required to maintain accreditation. Pharmacy owners will need to be sure to understand the requirements that they will need to meet to receive DMEPOS accreditation.

Eligibility Requirements

Pharmacies will be required to complete the DMEPOS accreditation process through the National Association of Boards of Pharmacy (NABP). To qualify for accreditation, a pharmacy will need to meet the following basic eligibility requirements:

  • A pharmacy must have the proper licenses and be in good standing in all areas where it conducts business.
  • A pharmacy must be in a commercial location rather than a personal residence, and it must have been in operation for at least 30 days while complying with all applicable state laws and regulations.
  • A pharmacy must have a licensed pharmacist-in-charge who manages pharmacy operations and staff members.
  • A pharmacy must predominantly serve human customers (as opposed to prescriptions for veterinary medicine), and it must fill prescriptions for at least 10 human patients.

Quality Standards

The Centers for Medicare & Medicaid Services (CMS) also maintains standards for quality that pharmacies will be required to meet to obtain accreditation as a supplier of DMEPOS. These standards address:

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IL license defense lawyerChiropractors provide essential care for many patients, helping them address issues that affect their back, neck, and spine. As is true for other medical professionals, chiropractors are required to obtain and maintain a professional license. Unfortunately, some chiropractors may face discipline from the Illinois Board of Chiropractors/Physical Therapists based on fraud, substance abuse, unprofessional conduct, criminal convictions, or misleading advertising. In addition to avoiding these issues, chiropractors may also need to address complaints that they have provided substandard care to patients.

Complaints of Substandard Chiropractic Care

While spinal manipulations performed by chiropractors can provide many benefits for patients, they can sometimes have adverse effects. To minimize the risks of harm to patients, chiropractors should always focus on preserving and protecting a patient’s overall health, ensure that patients are fully informed, and refer patients to other medical providers when necessary. Claims of substandard care by chiropractors may be based on:

  • Lack of informed consent - Chiropractors should be sure that patients understand the treatment they will receive, the potential risks of a procedure, and the other options for treatment that may be available. In some cases, a patient may claim that they suffered an injury because a chiropractor did not fully inform them of this information or give them the opportunity to consult with other providers.
  • Failure to consider a patient’s medical history - Patients may have underlying health conditions that could increase the risks of injury during a chiropractic procedure, such as osteoporosis or cancer in the spine. Chiropractors should fully review a patient’s medical records to identify any concerns, and they may need to consult with other medical experts before providing treatment.
  • Failure to perform the proper diagnostic testing - X-rays or other imaging tests can provide a chiropractor with essential information about a patient’s condition, and they may uncover issues that could cause complications, such as bone abnormalities in the spine. A patient may claim that a chiropractor failed to order the necessary tests or properly consider test results.
  • Negligent manipulation of the neck and spine - If chiropractic procedures are not performed correctly, a patient may suffer injuries such as pinched nerves, herniated discs in the spine, fractured vertebrae, or damage to arteries in the neck, which can result in a stroke.

When defending against claims of substandard care, a chiropractor may provide documentation or other evidence showing that they followed all proper procedures and received informed consent from patients. By demonstrating a history of providing quality chiropractic care and following all applicable regulations, chiropractors can avoid disciplinary action that may affect their ability to continue to practice.

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IL license defense lawyerDoctors and other medical professionals are required to meet a large number of requirements before they can practice medicine. These requirements include obtaining a medical degree from a qualified medical school, completing a multi-year residency training program, and obtaining a medical license. However, a person’s training will not end at this point, and to ensure that they are providing quality medical care to patients, medical professionals will need to maintain up-to-date knowledge of medical science and standards while continually working to improve their skills.

In addition to meeting licensing requirements, doctors and medical providers will often obtain medical board certification from specialty boards such as the American Board of Pediatrics or the American Board of Surgery. This certification demonstrates that they meet high standards of care and are continually improving their knowledge and skills. To maintain board certification, providers will need to participate in continuing medical education, and they must pass assessments to ensure that their knowledge is up-to-date and that they are providing quality medical care to patients.

Reasons for Loss of Board Certification

In some cases, providers may face the loss of their board certification if they fail to meet the ongoing requirements that show that they are continuing to improve their knowledge and skills and providing the best possible care for patients. Fortunately, medical specialty boards offer a variety of programs and initiatives to help providers obtain education, further their knowledge, and meet the requirements to maintain certification.

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Il license defense lawyerMedical providers that prescribe, dispense, or handle controlled substances are required to follow all applicable laws and regulations related to these drugs. The Drug Enforcement Administration (DEA) monitors providers to ensure that controlled substances are being used correctly, and it may take action to address any potential violations of the law. As part of its ongoing efforts, the DEA often conducts audits and inspections, and providers who have received a Notice of Inspection from the DEA will want to understand their rights and how they can protect themselves from consequences that could affect their DEA registration or their professional license.

Understanding DEA Inspections

The DEA performs regular, routine audits of medical providers that have a controlled substance registration. Inspections may also be performed as part of a larger investigation related to possible drug diversion, including in cases involving reports or claims of unlawful prescribing, unlawful dispensing, or conspiracy to possess or distribute controlled substances.

While the DEA may obtain a search warrant before performing an inspection, in most cases, a provider will receive a Notice of Inspection. This notice will follow a standard form (DEA Form 82), and it will include the name and address of the premises being inspected, the name and title of the owner or operator in charge of the premises, the date and time when the inspection will be performed, and the signature of the person performing the inspection. Typically, a registrant must provide informed consent before an inspection can be performed, and they have the constitutional right to refuse an inspection. Informed consent is given by signing a written statement in which a provider will verify that they understand that the results of an inspection could be used as evidence if the DEA or other law enforcement officials decide to pursue criminal drug charges.

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IL defense attorneyOpioid abuse and the abuse of other prescription drugs are at an all-time high in the United States. Pill mills are among the major sources of these drugs. As a result, federal and state agencies, as well as licensing boards have started cracking down on the prescribing of pain medications. In fact, facilities that work with the chronically ill are facing intense scrutiny, as are advanced practice registered nurses since they work under prescriptive delegation. This extra attention, though not always warranted, places the licensing status of nurses at risk. Learn more about the investigation process and how to protect your nursing license with help from the following information.

Investigations Can Be More Like Fishing Expeditions

Investigations for matters relating to prescriptive authority or the “excessive” writing of pain prescriptions may be closed if the Illinois Board of Nursing lacks evidence. Alternatively, the investigation could go another way. Something you say could be misinterpreted as evidence in a prescription abuse case, or the investigation could turn into a fishing expedition. The investigator might start looking for any sort of infraction. He or she could even use what seems like an innocent conversation to gather evidence against you for a matter completely unrelated to the initial query. This is why it is so critical that you understand the investigative process, the risk to your nursing license, and how to protect it.

Protecting Your Nursing License

First and foremost, you must understand that the Board of Nursing is not your ally. The Board is not necessarily interested in preserving your practice or offering you leniency. The Illinois Board of Nursing was established to protect the public, but Board representatives can be almost manipulative in their investigations. Moreover, they are unlikely to inform you of your rights—especially your right to consult an attorney before ever speaking with them. In fact, some investigators may even attempt to use their authority or an air of urgency to coerce you into speaking with them before you have had the chance to obtain legal counsel. Do not let them do this to you! Know your rights.

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IL defense lawyerMost Illinois physicians are familiar with the Illinois Medical Board. It is where they obtained licensing status, and it is a constant concern to their practice. However, fewer people—including some doctors— know about the Federation of State Medical Boards (FSMB) and the role it plays in their lives. Learn what it is and why it is important with help from the following information.

The Federation of State Medical Boards

Each state has its own licensing board, and the Federation of State Medical Boards ties them all together. It represents the 70 medical boards in the United States and its territories, including the District of Columbia. It offers policies, education, programs, and additional services to the state boards so that they can function effectively. The FSMB also enables state-to-state sharing of physician information. By far, that sharing is likely the most concerning issue for physicians.

How FSMB Sharing Can Impact Your Practice

The FSMB sharing allows state boards to look up disciplinary actions carried out by other state boards. So, if you lose your medical license or have it suspended in one state and then try to move, you may still be barred from practicing medicine. If you come under investigation, fail to see the investigation through to completion and move, the new state may have access to that information as well. Patients can also use the FSMB to check licensing issues in other states. With this in mind, even if an investigation seems arbitrary, it is important that you protect your license to the best of your ability.

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IL license lawyerSocial media has dramatically changed the way people interact with one another, and it has become a large part of life for many people. In fact, a recent study found that about 244 million Americans—about two-thirds of the entire population!—use some type of social media. Many professionals, including lawyers, accountants, and consultants, maintain various social media accounts, as do many doctors, psychologists, dentists, and other healthcare professionals. In light of modern privacy laws, however, medical professionals must be sure that their social media posting remains ethical and compliant with the standards that apply to such individuals.

Privacy and Ethics

A healthcare professional is required to follow a variety of privacy laws, the most notable of which is the Health Insurance Portability Act—more commonly known as HIPAA. While there are many elements to HIPAA, one of the law’s primary functions is to ensure that patient’s personal and healthcare information is well protected. Unfortunately, not all medical professionals are as careful on social media as they should be, and sometimes, a doctor or nurse might post something that violates HIPAA, leading to the possibility of action from the state licensing board.

Keeping Yourself Safe

If you are a healthcare professional who uses social media for personal or professional reasons, there are few things you can do protect yourself from potential problems:

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IL license lawyerBy their very nature, most physicians—including Medical Doctors (M.D.s) and Doctors of Osteopathic Medicine (D.O.s)—tend to have an independent decision-making spirit. While they are also generally very intelligent and dedicated to their patients, the responsibilities that come with gaining admitting and practicing privileges at a particular hospital can sometimes seem to conflict with a doctor’s sense of independence.

In addition to standards of care, hospital privileges also involve collegial, social, and legal elements that are more complicated than just taking care of patients. A physician who does not live up to all of a hospital’s expectations could quickly find that he or she is in danger of losing membership on the hospital’s medical staff.

Avoid These Types of Behaviors

It is understandable that concerns over the level of care that a physician provides could lead to the possible suspension or termination of the doctor’s hospital privileges. Such concerns could pertain to the doctor’s bedside manner, the failure to seek approval before trying unorthodox treatments, or not reaching out to specialists or consultants for questions outside of the physician’s area of specialty. Repeated incidents could become problematic and lead to the hospital suspending your privileges.

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IL medical license defense lawyerAccording to the Centers for Medicare & Medicaid Services (CMS), there are currently more than 60 million Americans who are enrolled as Medicare beneficiaries. This number includes individuals enrolled in “original” Medicare as well as in Medicare Advantage plans with private insurers. In order to be able to serve this large portion of the population, a medical provider must enroll as a Medicare provider and keep that enrollment in good standing. This means the provider must meet all of the requirements set forth by CMS and avoid behaviors that could lead to a revocation of the provider’s Medicare status.

Revocation of Medicare Enrollment

Under §424.535 of the Code of Federal Regulations, there are many different reasons for which a provider could have his or her Medicare enrollment status revoked. They include noncompliance with enrollment requirements, causing harm to patients, being convicted of certain felonies, improper medication prescribing practices, and failing to comply with CMS reporting requirements, among many others.

As a provider, you could also lose your Medicare enrollment status for abusing your billing privileges. Under the law, abuse of billing privileges includes but is not limited to:

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IL license defense lawyerHave you recently learned that your medical practice or pharmacy is being audited or investigated by the U.S. Drug Enforcement Agency (DEA)? You might have discovered this information by chance or have been informed directly by a DEA agent. Either way, a DEA investigation can be frightening, especially if your livelihood depends on keeping your DEA registration and your professional license. The good news is that our firm is equipped to help healthcare professionals of all types in all types of DEA-related matters.

DEA Tasked With Helping to Manage the Opioid Crisis

Over the last few years, the misuse and abuse of opioid drugs have become major problems throughout the country. In fact, the situation is serious enough that the acting U.S. Secretary of Health and Human Services declared a public health emergency in 2017, and health officials began using the word “epidemic” to describe the widespread nature of the crisis. At the time, the Centers for Disease Control and Prevention estimated that 91 per day were dying from opioid overdoses.

As part of the effort to address the crisis, President Trump has utilized federal law enforcement agencies, including the DEA, to play an important role. When it comes to medical practices and pharmacies, the DEA is primarily responsible for ensuring that doctors and pharmacists are prescribing and dispensing controlled substances in accordance with the law and proper clinical guidelines. In most cases, this means investigators are looking for possibly excessive combinations of drugs listed on Schedules II and III by the Controlled Substances Act. If the DEA launches a full-scale investigation, it generally means that there is suspicion of systematic and severe violations.

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IL license defense lawyerBecause of their important role in providing for the care and health of their patients, Illinois nursing homes are subject to oversight from both the Illinois Department of Public Health (IDPH) and the federal Centers for Medicare and Medicaid Services (CMS) to ensure they are in compliance with regulations. With the additional risks that the COVID-19 pandemic poses for nursing home residents, additional guidelines have been put in place to promote their safety. Now more than ever, it is important for nursing homes to take the necessary measures to avoid violations that could impact their licensure.

Guidelines for Illinois Nursing Homes During COVID-19

Based on guidance from the Centers for Disease Control, CMS has issued guidelines for the safe operation of nursing homes and other long-term care facilities throughout the United States. For example, nursing homes must:

  • Require staff to wear personal protective equipment (PPE), including masks, gloves, gowns, and visors
  • Regularly screen residents, staff, and visitors for symptoms of COVID-19
  • Use proper hand hygiene
  • Follow a plan for testing and monitoring residents and staff for COVID-19
  • Restrict visitation, communal dining, and group activities

CMS has also instituted a system for removing some restrictions in phases for nursing homes that are able to control the spread of COVID-19.

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IL license lawyerPsychologists provide an important service for their patients, who rely on their expertise for therapy and treatment of a wide range of mental and behavioral health issues. Psychologists who breach their patients’ trust may face serious consequences, including the loss of their license. In some cases, they may even face medical malpractice lawsuits.

What Is Medical Malpractice?

Medical malpractice occurs when a healthcare professional breaches his or her duty of care to a patient, resulting in the patient’s injury or harm. For physical healthcare providers, some of the most common forms of malpractice are surgical errors, improper medication or prescriptions, misdiagnosis, and misinterpretation of test results or patient history.

While psychologists may not have a medical degree, they do provide a form of healthcare, and prescribing psychologists are licensed to prescribe medical treatment. Therefore, they may face medical malpractice claims related to improper prescriptions, misdiagnoses, or failure to diagnose a mental health condition. According to the American Psychological Association (APA), some psychologists also face claims of malpractice due to emotional abuse or sexual misconduct with their clients.

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IL defense lawyerThe global pandemic COVID-19 has hit the U.S. especially hard, with over 199,000 confirmed cases in Illinois alone. From the beginning, this virus has led to overfilled hospital beds and overworked medical professionals. With no vaccination in sight and a high demand for doctors, nurses, and other medical professionals, the U.S. has been forced to reevaluate their licensing procedures and state-by-state restrictions. It is common for states to adopt emergency licensing processes in response to natural disasters and their aftermath. Many states have followed this trend by enacting emergency-response licensure laws to allow volunteers from other states to practice their profession without being required to seek out licensure in that specific state.

Uniform Emergency Volunteer Health Practitioner Act

The Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) is legislation that was initially developed in 2006 and is being modeled by many states during the COVID-19 pandemic. This legislation allows any participating state, Illinois included, to recognize out-of-state medical licenses during a declared state emergency. All practitioners who wish to participate in this reciprocal-licensing program must register to do so.

Illinois-Specific Legislation

Aside from the UEVHPA, which has been adopted by most states during this time, Illinois has enacted a few regulations of its own. Under Gov. Pritzker’s direction, the Illinois Department of Financial and Professional Regulation is allowing healthcare workers whose licenses have recently expired to temporarily restore their licenses to assist with COVID-19 patients. Physician assistants and doctors who have expired or inactive licenses from less than three years ago are able to return to work without paying any required licensing fees or making further progress on their education requirements. Additional leeway has been given to nurses and respiratory therapists, giving them a five-year pass rather than the three-year allotment given to doctors and physician assistants.

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IL license defense lawyerIt is fairly recognized that nursing school is not an easy path to take. While slightly less rigorous than medical school, those who wish to be Illinois nurses are still required to take intense courses aimed at preparing them for in-field work and the difficult exam, known as the NCLEX-RN, to become a registered nurse. This exam is a national, standardized test to ensure that future nurses are fully capable of taking care of patients and performing other medical duties.

Since many nursing students take their NCLEX exam coming out of college, they will typically receive nursing licensure in the state where they went to school. However, it is unlikely that these medical professionals will never move out of state. For those moving to Illinois, there is a particular process that they must follow to become an Illinois certified nurse.

Out-of-State Licensure

If a nurse moves from one state to another and still intends on working in this field, they will need to receive “licensure by endorsement” in the new state that they are moving to. In other words, out of state nurses must receive license verification and endorsement from the previous state(s) that they worked in. This includes the current state, the original state (if different), and any other state that the nurse has practiced over the past five years. Illinois requires nurses to provide their NCLEX results, either from the state of original licensure or the testing company. These endorsement candidates can be issued a temporary license to begin work while the paperwork is being processed.

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IL license defense lawyerThere are many types of professions that are regulated in Illinois, such as cosmetology, psychology, financial services, and even architecture. One regulated profession that does not come as much of a surprise is dentistry. The Illinois Department of Financial and Professional Regulation (IDFPR) oversees the licensing, continuing education, practice, and discipline of dentists and related professions in the state. Becoming a dentist takes years of hard work and study, but getting your dental license requires you to know all of the requirements before you apply for your Illinois dental license.

General Dentistry Licenses

Like many other health-related professions in Illinois and throughout the country, you must have a license to practice dentistry in Illinois. To obtain a license to practice general dentistry, you must:

  • Be at least 21 years old
  • Be of “good moral character”
  • Provide evidence that you graduated from a dentistry school accredited by the American Dental Association
  • Present evidence that you passed both parts of the National Board Dental Examination
  • Pass an examination conducted by one of the five regional testing services: the Central Regional Dental Testing Service, Inc. (CRDTS); the Southern Regional Testing Agency, Inc. (SRTA); the Western Regional Examining Board (WREB); the North East Regional Board (NERB) or the Council of Interstate Testing Agencies (CITA)

Anesthesia Permits

In many cases, a dentist or dental specialist such as an orthodontist or oral surgeon will want to be able to administer anesthesia in their office. Legally, they cannot do that without first applying for and receiving the proper anesthesia permits. Illinois ranks its dental anesthesia permits at varying levels. A dentist with a general practicing license can use minimal sedation, where consciousness is only slightly affected. However, any further forms of sedation, such as moderate sedation, deep sedation, and general anesthesia require further education, experience, training, and other requirements.

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IL license lawyerAt some point, we have all felt exhausted, cynical, or unhappy with our jobs. This is called burnout and it can have negative effects on job performance and personal happiness. Physician burnout has been one of the topics of concern among the medical community for a few years now. According to the American Medical Association (AMA), more than 40 percent of all physicians in the United States report experiencing signs of burnout. Physician burnout has been linked to higher rates of medical errors, lower quality of patient care, and a higher rate of physician drug and alcohol abuse and/or addiction. Physician burnout and its associated outcomes could have serious implications for your Illinois medical license.

Signs of Burnout

Burnout is a long-term response to work-related stress that is characterized by emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment. Burnout is not unique to medical professions, but physicians tend to be more prone than others. Other symptoms of burnout can include:

  • Fatigue
  • Loss of empathy
  • Cynical or negative attitudes toward patients
  • Decreased productivity
  • Detachment
  • Depression
  • Suicidal thoughts

Effects of Burnout

Physician burnout has been considered by many to be an epidemic that is consistent with providers across the country. Not only does burnout severely impact the provider’s own physical and mental health, but it can also impact their job performance, future job prospects, and patient care and health. According to a study published by researchers at the Stanford University School of Medicine, physicians who reported symptoms of burnout were more than twice as likely to make a medical error than physicians who did not report symptoms of burnout.

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IL license defense lawyerIn the healthcare industry, there are many safeguards put in place to protect patients. When it comes to medication and pharmacies, it is no different. PBM pharmacy audits are conducted both for the sake of the pharmacy benefit manager (PMB) and for you, the pharmacy owner. A PBM audit can be a stressful experience for a pharmacy, especially a small, independent one, but many pharmacies cannot operate at desired capacity without also working with a PBM. If you have an upcoming PBM pharmacy audit, proper preparation is key to success.

Documentation is Extremely Important

For many pharmacies, but especially independent pharmacies, documentation is often an area that needs attention. When your PBM auditor comes to your pharmacy, they may request to see certain documentation that could be from months or even years ago. This documentation could be anything to do with things such as supply changes, such as going from a 30-day supply to a 60-day supply, or early refills. Having your documentation completed, thorough, and organized will save you much stress during the audit.

Consistency Is Expected

Part of the job of a PBM auditor is to make sure that each patient receives the same standard of care when they use your pharmacy. This is accomplished by making sure that all employees are following the same rules and policies while they perform their job. When your PBM auditor is at your pharmacy, they will be looking for any errors made by your staff, such as checking the amount of medication dispensed or ensuring all of the proper forms and documentation are filled out. It is a good idea to have an official standard operating procedure (SOP) written out and distributed to all of your employees so that they understand what is expected of them every time they fill a prescription.

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