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illinois medical license defense lawyerLast year, Hulu produced the limited series, “Dopesick.” The show revealed how the opioid epidemic that has gripped the U.S. started and how it has affected people. One of the characters in the show, Dr. Samuel Finnix, is a doctor in a small town who is persuaded by an OxyContin salesperson to prescribe the drug to his patients. Not only do many of his patients become addicted to the drug, but the doctor also develops an addiction. Sadly – although the character is a fictional one – he is based on many true-life stories that have found themselves in the same place the character does.

Addiction in Medical Professionals

According to national statistics, more than 100,000 medical professionals – including physicians, nurses, therapists, technicians, and other health professionals – are struggling with abuse or addiction to Oxycodone, Fentanyl, or other narcotics. One in 10 doctors will abuse or become addicted to drugs or alcohol during their career, while 20 percent of nurses struggle with some form of addiction.

Although anyone can become addicted to narcotics, the unique issue with medical professionals is they have easier access to these drugs.

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illinois nursing license defense lawyerIt takes strong dedication to be a hospital nurse. The majority work long shifts, with hours that go into the double digits, dealing with lack of sleep and heavy workloads, all while trying to provide patients with the best care possible. The hospital work culture can – and often does – leads to errors that can ultimately put a nurse’s license at risk.

Hospital Work Culture

Several years ago, the Vickie Milazzo Institute in Houston conducted a survey of nurses throughout the country. The results found that most of them were overworked and stressed, as well as feeling underutilized and underappreciated.

More than half of the nurses surveyed said that the shifts they work make it impossible to get enough sleep during the week. Between the double-digit shift hours and the on-call availability they are required to work, it is not uncommon for a nurse to pull a 24-hour or even a 36-hour shift.

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illinois professional license defense lawyerIn many criminal cases, the person who has been charged will often enter into a plea agreement with the prosecutor’s office instead of going to trial and letting a jury decide their guilt or innocence. If it appears that the prosecutor has enough evidence to convict them, a defendant agrees to a plea bargain in order to receive a lesser sentence than what they would receive if convicted.

For most people, agreeing to a plea bargain will conclude the legal process for them. However, for a person who holds a professional license, agreeing to a plea bargain in a criminal case could jeopardize that license and their future.

Professional License Holders and Criminal Charges

The Illinois Department of Financial and Professional Regulation (IDFPR) oversees multiple state licensing boards, including medical, nursing, dental, and real estate. Not only do these boards address professionals who have been accused of improper business practices, but they also investigate those who have been charged with criminal offenses. If a board concludes that the professional violated the rules and regulations that the state requires of them, it has the authority to suspend or even permanently revoke that professional’s license and their ability to earn a living in their chosen profession.

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illinois license defense lawyerIt takes years of education, training, and dedication to become a successful psychologist in Illinois. Not only is there grinding coursework to get your degree, but there are also stringent requirements to obtain your license to practice in the state. Unfortunately, all it takes is one accusation of wrongdoing and a dedicated psychologist can find his or her career in jeopardy.

All licensure issues are handled by the Illinois Clinical Psychologists Licensing and Disciplinary Board, which falls under the Illinois Department of Financial and Professional Regulation (IDFPR). If you have been contacted by the board that you are under investigation, contact an Illinois professional license defense attorney immediately.

What Types of Complaints Can Trigger an Investigation?

There are many reasons why a patient may file a complaint against a psychologist. Some of the most common allegations filed with the board include:

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illinois license defense lawyerIn every state in the country, there are certain professionals who are required to hold a professional license that is issued through the state. In this state, the Illinois Department of Financial and Professional Regulation (IDFPR) is the state agency that has regulation over all the different professional boards that issue these licenses and are in charge of oversight. Some of these boards include the Illinois Medical Board, Illinois Board of Nursing, Illinois Board of Pharmacy, the Illinois Dental Board, and Illinois Board of Clinical Psychologists/Social Workers.

When there is an issue with a professional license holder, the board that issued that license will begin an investigation into the allegations made and then make a decision on what – if any – action should be taken against the license holder. The following are some of the more common reasons why investigations take place. If you have been notified that you are under investigation, contact an Illinois professional license defense attorney immediately.

Alcoholism or Addiction

Addiction is one of the most common complaints that are made against a professional license holder that can result in an investigation and subsequent license suspension or revocation. Whether that addiction is to alcohol, drugs, or both, the impact that the addiction can have on the quality of care the individual can provide can be devastating.

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illinois license defense lawyerThe healthcare industry faces an ever-growing mountain of rules and regulations issued by the federal government that must be followed. Failure to adhere can result in fines, sanctions, and even a suspension or revocation of an individual’s professional license or the facility’s operating license. As new requirements issued for hospices as a result of the Consolidated Appropriations Act of 2021 go into effect in the fiscal year 2022, it is critical to understand what those requirements are.

Why the Change?

These new rules were created as a result of the findings of reports filed over the past several years that examined the results of hospice surveys by accreditors and regulators that found that at least 20 percent of these hospices had serious deficiencies. Some of the deficiencies cited in one report issued by the U.S. Department of Health and Human Services Office of the Inspector General (OIG) in 2019 included organizations that failed to manage patients’ pain, failure to make home visits, and even cited one incident where a patient’s feeding tube was infested with maggots.  

Special Focus Program

There are nine changes that U.S. Centers for Medicare & Medicaid Services (CMS) will be putting into effect. Each of these changes do have various effective dates. Some, such as the new requirement for each hospice program to set up a hotline, have already gone into effect. These changes have been made in the following sections:

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illinois license defense lawyerIn the past 20 years or so, there has been a concerted effort by the federal government to crack down on the number of fraudulent claims that are submitted to Medicare by medical providers. One of the ways that the government prevents fraudulent claims is through prepayment audits. If your practice has been notified that you are the subject of a prepayment audit, you should contact an Illinois professional license defense attorney for legal assistance.

Zone Program Integrity Contactors

Prepaid audits fall under the bailiwick of the Centers for Medicare and Medicaid Services. The agency often employs Zone Program Integrity Contactors (ZPICS) to conduct these investigations into potential waste, abuse, and fraud. In some cases, ZPICS will use methods to mine the practices’ algorithms in an attempt to see if they can find any abnormalities in billing which could indicate fraud is taking place.

Issues That Can Result in a Prepayment Audit

There are certain issues that can result in ZPICS knocking at your door or a denial of claims:

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illinois license defense lawyerIn 1996, the federal government passed the Health Insurance Portability and Accountability Act (HIPAA). The law was created to establish national standards to protect sensitive patient health information from being disclosed to any other party unless the patient consents. In order to implement the requirements of the standards, the HIPAA Privacy Rule was established. Entities that are subject to the Privacy Rule include healthcare providers, health plans, and healthcare clearinghouses. Violations of HIPAA can result in hefty civil fines and even criminal charges.

Examples of HIPAA Violations

There are a number of actions that could result in a violation allegation. These include:

  • The medical practice is a victim of a data breach.

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b2ap3_thumbnail_shutterstock_788107000.jpgAccording to data collected by John Hopkins patient safety professionals, medical errors are responsible for more than a quarter of a million deaths each year in this country. This major study used data collected over an eight-year period and put a spotlight on the dangers medical errors pose to patients. One of the most important factors in preventing these errors is the proper documentation by the nursing staff of the care provided to patients. Accusations of improper documentation by nurses can lead to disciplinary action or even suspension of your nursing license. The following are some of the more common documentation errors nurses are accused of making.

Illegible Writing

Although the majority of patient records are done electronically, there are still occasions where a nurse will need to handwrite patient information on a document or file. It is important that writing be done clearly and be legible for anyone who needs to read it.

Failure to Date/Time Entries

Some systems automatically enter the date and time of an entry, but if the system you are using does not offer that option, or you are handwriting the information, every entry should have the date, time, and your name.

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illinois license defense lawyerIn order to protect patients who are covered under federal health programs, such as Medicaid and Medicare, the federal government has put in place certain laws that medical providers are required to adhere to. The Department of Health & Human Services Office of Inspector General (OIG), the Centers for Medicare & Medicaid Services (CMS), and several other federal agencies are in charge of making sure these laws are followed, and to investigate and prosecute those who do not. We have discussed two of them – the Physician Self-Referral Law (Stark Law)  and the Federal Anti-Kickback Statute (AKS) – in prior posts. In this third and final post about these laws, we will discuss the False Claims Act.

The False Claims Act

Violations of the Stark Law result in civil penalties, while violations of the AKS result in criminal penalties. The False Claims Act (FCA) has both criminal and civil penalties, depending on what the government thinks the intent of the individual being charged was.

Some examples of false claims include:

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b2ap3_thumbnail_shutterstock_1692451894.jpgThere are several federal laws that have been put in place in order to protect patients by ensuring that there are no financial incentives or other conflicts of interest regarding referrals by healthcare providers. In our last post, we discussed the seriousness any accusations of violating the Physician Self-Referral Law (Stark Law) can have on a physician’s career. In this post, we will address the Federal Anti-Kickback Statute.

Federal Anti-Kickback Statute

Unlike the Stark Law, in which any violations are met with civil penalties, the Anti-Kickback Statute (AKS) is a criminal law, meaning that if a provider is found guilty of violating the statute, they now have a criminal record and could even face jail time depending on the circumstances of their case. Any criminal charges are classified as a felony.  

Under the AKS, it is a criminal offense to either exchange or offer to exchange something of value in order to persuade business referrals that would be reimbursed by any federal health care program, such as healthcare services and prescription medications.

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b2ap3_thumbnail_shutterstock_1100432048.jpgThere are many federal and state laws that physicians are required to abide by, including laws that address fraud and abuse. According to the Office of Inspector General, U.S. Department of Health and Human Services (OIG), the most serious of these laws include the Physician Self-Referral Law (Stark Law), the Anti-Kickback Statute (AKS), and the False Claims Act (FCA). Violations of these laws can result in severer penalties, including exclusion from federal health care programs, civil fines, loss of medical license, and even criminal penalties. In our next few posts, we will discuss each of these laws and how they may affect your practice. In this post, we will look at the Stark Law.

The Physician Self-Referral Law

The Physician Self-Referral Law, referred to as the Stark Law, bans doctors from referring patients to other medical providers for services that will be paid by Medicare, Medicaid, or other programs if the referring doctor or a member of their immediate family has any type of financial relationship with the medical provider they are referring. Basically, a doctor cannot refer a patient in exchange for receipt from that provider of anything of value. They also cannot present claims to Medicare or other healthcare program for referred services.

The Stark Law is meant to protect patients from procedures – and medical expenses – that are unnecessary. It also applies to all medical facilities, whether a small private practice or a large health care system. There are some exceptions to the Stark law, however, those exceptions are very limited.

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illinois license defense lawyerIn the healthcare industry, pharmacy benefit managers (PBMs) serve a pivotal role. In fact, a pharmacy would be unable to operate without having a contract with a PBM. The PBM serves as an intermediary between the pharmacy and the insurance company, negotiating rates and processing the majority of all prescriptions.

Under these contracts, the PBM also has the right to conduct an audit of the pharmacy to make sure that all terms of the contract and proper guidelines are being met. Any discrepancies found during the audit could result in not only the pharmacy being required to pay back funds they have received, but could also result in the PBM contract being terminated. One product PBMs have been laser focused on recently is the number of pharmacies purchasing diabetic testing strips from unauthorized sources.

Black Market Diabetic Testing Strips

There are currently more than 30 million patients diagnosed with diabetes in this country. Patients who have the condition are required to test their glucose levels each day. One of the most common ways to test is by using diabetic test strips. It is so common revenues from these test strips surpasses $8 billion a year.

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 b2ap3_thumbnail_shutterstock_1297756882.jpgOver the past few decades, the experience of labor and delivery for women has undergone dramatic changes. The process used to be a very clinical one, ending in a birthing experience that involved drugging the mother from the moment she arrived at the hospital and keeping the newborns in the nursery instead of with their mothers for the majority of their extended hospital stays.

The attitude about the birthing process has all changed to a much more family-intimate experience. This has also led to many women choosing to entrust their care to midwives instead of obstetricians. Some women even decide to have their babies born at home, whether by choice or because of the astronomical expense of a hospital delivery.

However, until recently, only those who were certified as nurse-midwives could provide Illinois women with this type of care, but a new law recently signed by the governor will create a new license process for midwives that does not require a nursing degree.

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b2ap3_thumbnail_shutterstock_139022960.jpgNo matter where you are in life or what your profession is, anyone can find themselves dealing with some kind of legal issue, whether it has to do with being charged with a DUI, stealing medications, fraud, or domestic violence. While these criminal accusations are serious for any individual, they can have even more dire consequences for an individual who holds a professional license. If you are a licensed professional in the state of Illinois and have concerns or questions regarding what you are required to notify the licensing board that oversees your profession, you should speak with an Illinois professional license defense attorney.

What Charges Need to Be Disclosed?

When a person who holds a professional license is charged with a crime, one of the first factors that need to be examined is whether the crime is related in any way to their profession. In the case of a medical professional stealing prescription medications from patients, that relation is pretty clear. There are other charges that are not so clear. For example, if a doctor is arrested for drunk driving, they may not feel this is something they need to report because it was not connected to their position.

However, the Illinois Medical Board may feel differently. When a person is arrested for DUI, it can sometimes indicate an alcohol problem. Although not every person arrested for drunk driving is an alcoholic, the board will likely initiate an investigation to determine if there is evidence of an alcohol problem – something that could be very dangerous for the patients the doctor is treating.

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illinois license defense lawyerSocial media platforms have become an integral part of many people's daily lives, often without realizing just how integral. People post photos, comments, opinions, and memes on Facebook, Instagram, Twitter, SnapChat, and several other sites on a regular basis. While social media is often a good place for keeping in touch with family and friends, and even networking, it is crucial to be vigilant about what you are posting, especially if you work in certain fields, such as nursing. In fact, items from your social media posts could ultimately be used against you in any actions taken against you by the Illinois Board of Nursing.

Conduct That Is Unprofessional

Many of us have had the unfortunate experience of having someone tag us in a photo that we think we look horrible in. It is now out there for everyone to see. However, if you are tagged in a photo that also shows you engaging in behavior that may be considered inappropriate or unprofessional, the photos can be used as evidence against you as ground for any disciplinary action by the state nursing board.

Examples of these types of photos include ones where you may be seen drinking and partying. Maybe comments made on the photo could also be deemed inappropriate even if made at an attempt at humor, such as a joke about how inebriated you were.

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b2ap3_thumbnail_shutterstock_1188829789.jpgIn Illinois, there are a number of different professional licensing boards that all fall under the umbrella of the Illinois Department of Financial and Professional Regulation (IDFPR). Any individual who holds a professional license in the state of Illinois is under the oversight of whatever board issued that license. When there is a complaint or other issue filed against an individual, that board will be the one to investigate the complaint, determine if there is validity to it, and decide if any disciplinary action should be taken against the person who holds that license.

Anyone who has been notified that they are under investigation should contact an Illinois professional license defense attorney right away in order to ensure their rights are protected in any investigation and/or hearings that take place. Choosing the right attorney, however, is critical.

Hiring a Professional License Defense Attorney

There are a number of boards that fall under the IDFPR, including:

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oak brook medical license defense lawyerNot every job turns out the way we hope. It is not uncommon for a medical professional – just like any other profession – to find themselves at odds with their supervisor or manager. Although many of these disagreements may be worked out, there are unfortunately instances where no resolutions are able to be met and the employee either leaves or is fired. In extremely acrimonious situations, the employer may even make accusations of wrongdoing against the employee and threaten or actually file a complaint with the Illinois board that oversees that medical professional’s license. If you find yourself in this position, contact an Illinois medical license defense attorney right away for legal assistance.

Reporting Misconduct of an Employee

If an employer believes that one of their employees has committed some kind of act or behavior that violates the standards set forth by the state of Illinois, their employer not only has a right to report that violation, but they also have a legal duty.

For example, if a hospital has discovered that one of their nurses has a substance abuse issue and has been stealing prescription medications from patients for their own use, not only do they need to take the appropriate action against that nurse, but they also need to report the drug use and theft to the Illinois Board of Nursing. If they fail to take action, they could be putting patients’ lives at risk. They also leave their facility open to legal action should something tragic occur, as well as jeopardize their own licensing with the state.

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b2ap3_thumbnail_shutterstock_1348640414.jpgNurses are a special breed of people. They dedicate their lives to taking care of others, often at the expense of time spent with their own loved ones. To become a nurse, they spend several years going to school and training and continue that education during their careers to stay abreast of the most up-to-date medical care for patients and meet the requirements of the Illinois Board of Nursing. Given the amount of dedication and sacrifice a nurse pours into their career, it is imperative to take all the necessary steps to ensure their nursing license is protected. All it takes is one false or misleading allegation, and a nurse can find themselves facing disciplinary action or even loss of their nursing license.

Complaints that May Lead to a Nursing License Investigation

The Illinois Board of Nursing is tasked with overseeing all licensed nursing professionals in the state. A complaint made to the board will trigger an investigation into whether the allegations being made are true and – if they are – what disciplinary action is warranted. Any nurse who is notified by the board that there has been a complaint filed against them should contact an Illinois professional license defense attorney right away.

Some of the most frequent complaints filed against nurses include:

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oak brook professional license defense lawyerLast year, as the COVID-19 pandemic hit and the country went into lockdown, one of the many changes that were implemented was how doctors and other healthcare providers saw patients. Instead of in-person appointments, patients consulted with their physicians via telehealth video calls. Although much of the country has opened up, many doctors are still using telehealth for appointments. However, along with this newer technology comes new opportunities for healthcare billing fraud. It can also leave healthcare providers unknowingly committing a crime that can result in criminal charges and loss of their medical license.

Telehealth Expansion

Telehealth uses video technology to connect doctors with their patients for medical checkups. This technology allows patients to communicate with their doctors any medical concerns they have and allows doctors to provide medical advice and treatments, without the risk of exposing either party to COVID. While telehealth has been used for years in rural areas or areas where there are no nearby healthcare providers, its use has become very widespread throughout the country during and post-pandemic.

But this widespread use also brings about concerns of providers failing to meet the requirements and other guidelines that are needed to bill for an actual appointment. There are also concerns that a provider may give the patient unnecessary medications.

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