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CMS Audit Attorney in Oak Brook, ILMost medical providers, including doctor’s offices, hospitals, pharmacies, and other types of medical professionals, provide services to patients and accept payments through Medicare or Medicaid. Providers must meet a variety of requirements when doing so, and the Centers for Medicare and Medicaid Services (CMS) is tasked with ensuring that providers are in compliance. CMS may conduct audits of providers based on billing irregularities, issues related to record-keeping, or other concerns about potential noncompliance. During these types of audits, providers will want to understand the process that will be followed and the requirements they must meet. Failure to comply with CMS requirements or cooperate during an audit could result in the provider being excluded from providing services through Medicare or Medicaid.

Steps Followed in a CMS Audit

The Medicare/Medicaid audit process has four phases:

  1. Engagement and universe submission - Auditors will notify a provider of an audit and send an engagement letter that identifies the information that will be requested. This information will take the form of “universes,” which consist of data sets from a health plan, including Part C Organization Determinations, Appeals, and Grievances (ODAG) and Part D Coverage Determinations, Appeals, and Grievances (CDAG). After the provider submits the requested universes, auditors will assess the data provided and determine whether any other information is necessary. This phase will last six weeks.

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IL hospital review board lawyerFor many medical professionals, including doctors, surgeons, nurses, and physician assistants, the ability to provide services for patients in hospitals is crucial to their practice. Whether a person is a full-time staff member at a hospital or has courtesy privileges or surgical privileges, being able to see and treat patients at the hospital will ensure that they can provide quality medical care. This means that medical professionals will want to be aware of any issues that could lead to the loss of hospital privileges. By defending against this form of discipline, providers can avoid issues that may affect their medical license and their overall career.

Reasons for Loss of Hospital Privileges

In some cases, a person may face discipline to their hospital privileges due to issues involving the hospital. Accusations of substandard patient care or malpractice that occurred at the hospital may cause the hospital’s review board to take disciplinary action. These actions may involve a limitation on a person’s privileges, a temporary suspension of privileges, or a permanent revocation of the ability to see and treat patients at the hospital.

A hospital may also discipline a professional for issues such as violations of hospital policies or problems with other staff members. For example, a doctor who has acted abusively toward nurses or other members of a hospital’s staff, refused to accept constructive criticism or listen to suggestions from other providers, and publicly criticized the hospital and its staff members may be asked to explain this behavior by the hospital review board. The board may then choose to reprimand the provider and restrict or suspend their hospital privileges.

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IL license defense lawyerDoctors, nurses, pharmacists, and other medical professionals can face a great deal of scrutiny as they provide services to patients, especially when they prescribe or dispense controlled substances. In some cases, a professional may be accused of drug diversion, in which controlled substances are provided to patients for non-medical purposes or allowed to be illegally sold or delivered outside of the medical supply chain. Drug diversion is a serious offense, and it may lead to the suspension or revocation of a provider’s DEA registration, as well as the loss of a medical license, criminal charges, and other penalties. To avoid these types of consequences, medical professionals will want to make sure they are following the correct policies and procedures regarding controlled substances.

Preventing Drug Diversion

In many cases, a provider is accused of drug diversion based on their practices of prescribing or dispensing controlled substances to patients. To avoid these types of accusations, providers will want to be aware of how patients may attempt to obtain illegitimate prescriptions for controlled substances. A patient may show exaggerated symptoms or provide unconvincing explanations for why they need to receive a prescription in a short amount of time, or they may not cooperate with medical exams or allow a doctor to review their medical records. Patients who have specific requests for certain types of drugs or who seem to have extensive knowledge about a particular medication may be looking to obtain controlled substances for non-medical purposes.

When prescribing drugs, providers will want to make sure they fully evaluate patients to determine their pain medication needs. They should also use alternative pain relief treatments whenever possible and require patients to agree to pain management contracts to minimize the possibility of drug abuse. By following the requirements of their state’s Prescription Drug Monitoring Program (PDMP), medical professionals can avoid claims that they have issued illegitimate prescriptions for controlled substances.

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IL defense lawyerLicensed professionals invest a great deal of time, money, and effort to obtain the necessary education and training to practice in their chosen profession. After meeting all the requirements to obtain a professional license, a person will want to make sure they can maintain their license and avoid any issues that could affect their ability to continue working. Professionals should be aware that certain types of criminal convictions could lead to disciplinary action, and they will want to work with an attorney to address these issues and avoid the loss of their license.

Criminal Convictions That May Lead to License Suspension or Revocation

The Illinois Department of Financial and Professional Regulation (IDFPR) oversees licensed professionals, and it may choose to pursue disciplinary action against those who are convicted of certain types of crimes. Offenses that could lead to the suspension or revocation of a professional license include:

  • Driving under the influence (DUI) - Offenses related to drunk driving may result in discipline by the Illinois Medical Board, the Illinois Board of Nursing, or other IDFPR divisions that oversee medical professionals. These convictions may indicate that a person struggles with substance abuse, and a professional may be able to avoid or minimize discipline to their license if they receive treatment and meet the requirements put in place by the IDFPR.
  • Drug crimes - Medical professionals or others who prescribe or dispense controlled substances may face accusations of drug diversion or trafficking or other related offenses. In addition to facing discipline to their professional license, a person may face the loss of their DEA registration, as well as other consequences that affect their ability to practice.
  • Fraud - Criminal offenses related to the theft or misuse of other people’s financial or personal information may result in disciplinary action if they are related to a person’s profession. For example, medical professionals may face discipline because of a conviction for healthcare fraud, or the Illinois Real Estate Board may discipline a professional for offenses related to obtaining money under false pretenses.
  • Other felony offenses - Most of the time, professionals will face disciplinary action following a felony conviction. These offenses may include assault (including domestic assault or other domestic violence charges), robbery, burglary, or violent crimes

Contact Our Illinois Professional License Defense Lawyer

If you are facing discipline to your professional license because of a criminal conviction or for other reasons, The Law Offices of Joseph J. Bogdan, LLC can provide you with representation before the IDFPR. Attorney Bogdan will advocate on your behalf and work to minimize the consequences to your license and your career. To get the legal help you need with your IDFPR case, contact our Illinois professional license defense attorney at 630-310-1267 and schedule a free consultation today.

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IL medical license lawyerFor more than a year, the COVID-19 pandemic has caused interruptions to many people’s daily lives and activities. Fortunately, an end to this situation is in sight as vaccines are administered to people throughout the United States. To ensure that as many people can be vaccinated as quickly as possible, officials are taking an “all hands on deck” approach, and multiple different types of medical professionals have been authorized to administer these vaccines. To avoid any issues that could affect a person’s medical license, it is important to understand what steps should be followed to obtain authorization to administer vaccines, and medical professionals will want to make sure they are following the correct procedures at all times.

Who Can Administer COVID-19 Vaccines in Illinois?

Governor J.B. Pritzker has declared a public health emergency in the state of Illinois and issued emergency orders to allow certain types of licensed professionals to administer COVID-19 vaccines. Those who are allowed to administer vaccines include:

  • Licensed medical professionals - These include physicians, registered nurses (RNs), licensed practical nurses (LPNs), and advanced practice registered nurses (APRNs) with full practice authority, as well as APRNs and physician assistants who have a collaborative agreement with a licensed physician.
  • Pharmacists and pharmacy technicians - Pharmacists must have completed a training course authorized by the Accreditation Council on Pharmacy Education (ACPE). Pharmacy techs must have completed an ACPE-approved practical training program, and they must work under the supervision of a pharmacist. Pharmacists and pharmacy techs must complete at least two hours of immunization-related continuing pharmacy education, and they must also be certified in CPR.
  • Medical students - Medical residents can receive a temporary license allowing them to administer vaccines, and medical students who are enrolled in a medical college or who have recently graduated can administer vaccines under the direct supervision of a physician who is a faculty member of a medical college. Nursing students can administer vaccines if they are enrolled in a pre-licensure nursing program approved by the state of Illinois and are under the supervision of a qualified faculty member or a registered nurse preceptor. Physician assistant students who are enrolled in a pre-licensure program can administer vaccines while practicing under this program, and recent graduates who have not yet been licensed can administer vaccines under the supervision of a licensed physician assistant.
  • Dentists - A dentist’s scope of practice may be expanded to administer vaccines if they complete a four-hour practical training program and are certified in CPR.
  • Optometrists and veterinarians - These providers’ scope of practice may be expanded to administer vaccines if they complete a four-hour practical training program, have documentation of observation by a healthcare professional confirming their competency in administering injections, and are certified in CPR.
  • Unlicensed persons - Within the setting of a medical office or practice, and as part of an established doctor-patient relationship, a physician can delegate vaccination tasks to people who are not licensed in Illinois as healthcare professionals, as long as the person has the appropriate experience and training.

Contact an Illinois Medical Licensing Attorney

If you have questions about how administering COVID-19 vaccines will affect your medical license, or if you are facing any issues related to license renewal or disciplinary action, The Law Offices of Joseph J. Bogdan, LLC can provide the legal help you need. Contact our Illinois medical license defense lawyer today at 630-310-1267 to schedule your complimentary consultation.

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IL medical license lawyerOver the past decade, marijuana has been recognized as a substance that can provide patients with a number of medical benefits. Many states, including Illinois, have authorized the use of medical marijuana for patients with certain types of conditions. However, doctors, nurses, or other medical professionals will need to make sure they are following the correct procedures and meeting all requirements when certifying patients to use medical marijuana. Failure to do so could result in disciplinary action by the Illinois Medical Board, the Illinois Board of Nursing, or another division of the Illinois Department of Financial and Professional Regulation (IDFPR).

Health Care Professional Certifications for Medical Cannabis

Before applying for a medical cannabis registry identification card, patients in Illinois will need to receive a certification from a medical professional stating that they have a qualifying debilitating condition. Health care professionals that can provide this certification include medical doctors, doctors of osteopathic medicine, advanced practice nurses, physician assistants, and advance practice registered nurses with full practice authority.

Debilitating conditions that will allow a patient to qualify for the use of medical marijuana include HIV/AIDS, Parkinson’s disease, cancer, glaucoma, Hepatitis C, Crohn’s disease, migraines, seizures, rheumatoid arthritis, and traumatic brain injury. The Opioid Alternative Pilot Program also allows patients who could receive prescriptions for opioid painkillers to qualify for the use of medical cannabis.

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IL license defense lawyerAround 28% of all health care services in the United States are paid for through Medicare, Medicaid, or other federal programs. Because of this, health care providers need to comply with all applicable requirements, since being unable to provide services through these programs can eliminate a major source of revenue. The Office of Inspector General (OIG) for the federal Department of Health and Human Services (HHS) maintains a List of Excluded Individuals/Entities (LEIE), and any providers or organizations that are included on this list cannot receive payments from federal healthcare programs. Medical providers will want to understand the issues that could cause them to be included on this list and the actions they can take to prevent exclusion from Medicare or Medicaid programs.

Reasons for Exclusion

In many cases, a provider may face exclusion by the OIG due to charges of health care fraud or other offenses. The OIG has the discretion to issue a permissive exclusion if a provider is convicted of misdemeanor health care fraud or a misdemeanor related to illegal prescribing or dispensing of controlled substances or if their medical license has been suspended or revoked. Felony convictions for healthcare fraud or controlled substances, convictions related to abuse or neglect of patients, or any convictions for fraud against Medicare or Medicaid will result in a mandatory exclusion.

Effects of Being on the OIG Exclusion List

A provider who is on the LEIE will be barred from receiving payments for services through federal programs. If an excluded person submits a claim for payment through a federal program, they may face a civil monetary penalty (CMP) of up to $10,000 for each service furnished. In addition, an organization that employs or contracts with an excluded person may face a CMP if any services provided by the person were payable through Medicare or Medicaid. These services may include direct or indirect patient care, administrative services, or other prescriptions, items, or services provided at the direction of the excluded person. Because of these penalties, many hospitals and medical offices will not hire or contract with a service that employs a person who is on the LEIE.

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IL license defense lawyerDoctors, 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.
  • Take care when prescribing or dispensing controlled substances - Providers may be disciplined if they have prescribed, dispensed, or administered any controlled substances for reasons other than accepted medical purposes. In addition to discipline to their medical license, providers may face the loss of their DEA registration or even criminal prosecution. To avoid these issues, you should ensure that you are following the correct practices when prescribing or dispensing controlled substances, including requiring patients who use opioids to participate in pain management plans, participating in a Prescription Drug Monitoring Program (PDMP), and making sure drugs are not prescribed or dispensed for patients who have known addictions.
  • Take care of your physical and mental health - A provider may face disciplinary action if they have any physical illness, mental illness, or disability that interferes with their ability to practice medicine. By ensuring that you are physically healthy and are receiving treatment for any mental health issues, you can avoid any concerns about your ability to provide the quality of care your patients deserve.

Contact Our Illinois Medical License Defense Attorney

Even if you follow all of the steps above, you may find yourself under investigation by the IDFPR based on claims that you have violated the standards of ethical conduct or committed other violations of state or federal laws and regulations. In these cases, you need professional legal representation by an attorney who can protect your rights and help you avoid discipline that will affect your ability to practice. The Law Offices of Joseph J. Bogdan, LLC can assist with your case, and we will work to protect your medical license and your career. Contact our Illinois professional license defense lawyer today at 630-310-1267 to arrange a complimentary consultation.

 

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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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