Psychologists and therapists provide essential care for many people, helping them address issues related to mental health and working to ensure that they can maintain positive relationships with others. However, because psychologists discuss the sensitive details of people’s personal lives, they may sometimes be accused of unethical or unprofessional conduct. In these cases, a person may be investigated by the Illinois Department of Financial and Professional Regulation (IDFPR), and they may be subject to disciplinary action by the Illinois Board of Clinical Psychologists. Those who are facing discipline that could affect their professional license will want to work with an attorney to determine their best options for addressing these issues.

Forms of Unprofessional Conduct That Could Lead to License Discipline

There are multiple actions that a psychologist can take that could be interpreted as unprofessional or unethical, including:

There are multiple reasons why medical professionals may face disciplinary action. Certain types of criminal convictions, accusations of medical malpractice or unethical practices, or the loss of a DEA controlled substance registration are just a few of the many issues that may result in discipline. In these cases, the Illinois Medical Board, the Illinois Board of Nursing, or another division of the Illinois Department of Financial and Professional Regulation (IDFPR) may perform an investigation and pursue disciplinary action. Those who have had their medical license suspended or revoked or who have faced other forms of discipline will need to understand their options for restoring their license and resuming their practice.

Types of Disciplinary Action

Depending on what the IDFPR believes is an appropriate response to issues that warrant discipline, a person may be subject to a number of disciplinary actions or restrictions. Types of discipline that may affect a person’s practice include:

• Probation - Restrictions may be placed on a person’s practice for a definite or indefinite period of time. In addition to following all terms and conditions, a person may be regularly monitored by the IDFPR’s Probation Compliance Unit.

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For medical professionals, few things can be as worrisome as the possibility that they could lose their medical license. If you have been notified that you are being investigated for potential license discipline by the Illinois Department of Financial and Professional Regulation (IDFPR), you will most likely be concerned about how this will affect your ability to maintain your license and continue practicing medicine. In these situations, doctors will need to work with an attorney to gain an understanding of the procedures followed during a case before the Illinois Medical Board and the steps they can take to protect against the loss of their license.

Steps Followed in an IDFPR Investigation

An investigation of a doctor or medical professional may be initiated following a complaint by a patient or because of other issues, such as the loss of hospital privileges or the revocation of a provider’s DEA registration. A license discipline case will usually follow these steps:

1. Investigation - IDFPR investigators will look into a complaint or any other issues that may indicate that a doctor has violated the Medical Practice Act. They may contact the provider to request information or conduct interviews, and information may also be gathered from other sources, such as a hospital, pharmacy, or health insurance company. The Illinois Medical Board’s Complaint Committee will review the results of the investigation and determine whether to send the case to the Prosecution Unit or close the case. 

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Medical providers who prescribe or dispense controlled substances are required to maintain a registration with the Drug Enforcement Administration (DEA). If the DEA believes that a person has acted unlawfully when prescribing or dispensing controlled substances, it may take action to suspend or revoke a provider’s registration. In these cases, a provider can request an administrative hearing where they can present evidence showing why their registration should not be suspended or revoked. Those who need to address these issues will want to be aware of some potential rule changes that could affect administrative hearings in the future.

Proposed Rule Changes by the DEA

In September of 2020, the DEA submitted a Notice of Proposed Rulemaking that would modify the time frames and procedures followed during administrative hearings. The proposed changes include:

• After being served with an Order to Show Cause, a person would be required to submit a request for an administrative hearing within 15 days. Currently, registrants have 30 days to request a hearing, and this change would significantly reduce the amount of time a provider will have to review the allegations in an Order to Show Cause and determine the best course of action to take.

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Most 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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