Studies estimate that more than 40 percent of doctors will be sued during their careers. As America becomes increasingly litigious, doctors can expect that rate to go up - and so can other healthcare professionals. Nurses, dentists, psychologists, social workers, and any other healthcare worker is at risk of any number of accusations - many of which may be partly false, unfounded, or stem from the accuser’s own mental unwellness.

Even in cases involving obviously false allegations, healthcare practitioners can find themselves defending their cause in front of their regulating board, to say nothing of the impact such allegations can have on the professional’s standing in their family and community. If you have been accused of any wrongdoing, it is crucial to retain experienced legal representation right away.

What Kind of False Accusations Can Healthcare Workers Face?

Medicine is a complex area of employment that involves interactions with patients, coworkers, financial processors, and more. Healthcare employees may face false accusations for a virtually limitless number of reasons, including, but not limited to:

Social workers play a crucial role in helping people work through their problems and become effective, well-adjusted members of society. Whether social workers practice in child welfare agencies, addiction services, schools, or private practices, they help vulnerable people and communities deal with real-world problems.

Unfortunately, because of the often public-facing nature of their job, social workers often find themselves targeted by dissatisfied clients, parents, or coworkers. Social workers also carry the burden of performing professionally at a very high standard, protecting vulnerable people even at the expense of their own needs or desires. Sometimes, social workers make mistakes that jeopardize their ability to practice their profession; other times, they are unfairly singled out for retaliation. Whatever the allegations against you, if you are a social worker facing accusations of ethical misconduct, negligence, or other misbehavior, you need the help of an Illinois professional license defense attorney.

What Kind of Behaviors Are Considered Ethical Misconduct?

Social workers have to be cautious in their actions towards clients and clients’ families. Behaviors that are intended to be harmless may be easily misconstrued, especially by those who struggle with mental health issues, and even the most well–intentioned professional can make mistakes. Common complaints against social workers that can result in investigations and sanctions include, but are not limited to:

Accusations of Medicare fraud or abuse can have a significant impact on a healthcare provider’s ability to practice his or her profession. In addition to limiting the kinds of patients a provider can serve, Medicare provider revocation can be involved without other sanctions that may prevent a doctor from practicing altogether and may involve hefty fines. In one recent example, a Kentucky doctor was fined $720,000 and suspended from federal healthcare programs for fifteen years for submitting false claims to Medicare and Violating the False Claims Act.

If you are facing accusations of Medicare fraud, you need experienced, aggressive legal counsel to help you manage the investigation in your favor. If you have already had your Medicare provider status revoked or suspended, a professional license defense attorney may be able to help you get your privileges back.

Why Would Medicare Provider Status Be Revoked or Suspended?

Because Medicare is a government program and the government relies on trustworthy practitioners to provide excellent medical care to potentially vulnerable patients, investigators with the Centers for Medicare and Medicaid Services (CMS) are motivated to find and investigate those who may be acting in ways that are not conducive to Medicare’s overall aims. A healthcare provider may face suspension, permanent revocation, or a reenrollment bar for many reasons, including:

Psychologists face a tremendous amount of responsibility as they attempt to treat patients for some of the most complex, difficult-to-understand mental illnesses imaginable. Although many psychologists help patients overcome difficulties and learn to manage mental illness in a safe, productive way, other times a psychologist’s professional practice may lead patients to further harm. In the most extreme cases, patients may take their own lives, potentially exposing the psychologist to professional discipline for their treatment methods.

If you are being accused of contributing to a patient’s suicide, it is essential to take these accusations seriously and to enlist help in defending your professional license. Even if you are convinced you did nothing wrong, you may be subjected to an investigation that could threaten your ability to practice.

Can a Psychologist Be Penalized For Certain Kinds of Practices?

While some professionals may understandably feel that a psychologist’s style of practice should remain between the psychologist and his or her patients (and perhaps the patient’s parents), professional guidelines and laws prohibit certain types of treatment. In one notable example from several years ago, a psychologist lost her license after incorrectly diagnosing an 11-year-old child with Reactive Attachment Disorder and making bizarre and unethical treatment recommendations, after which the child committed suicide.

Many different healthcare professionals need hospital admitting privileges. While doctors are perhaps most commonly thought of as using hospitals to practice medicine, other professionals, such as nurses who work in birthing centers next to hospitals, need admitting privileges, too. Not being able to admit patients to a hospital could put patients at risk of serious injury or death, and healthcare workers simply may not be able to do their job without hospital admitting privileges. Unfortunately, loss of hospital privileges can happen for a number of reasons. If you are being threatened with loss of admitting privileges or have already lost your admitting privileges, make sure you work closely with an Illinois medical license defense attorney.

Why Do Healthcare Professionals Lose Hospital Admitting Privileges?

People lose hospital admitting privileges for many reasons, although the most common are for issues related to not following hospital protocol and accusations of providing poor patient care. However, other reasons - such as abuse toward colleagues or falling short on an improvement agreement designed to increase the standard of your practice - may trigger the loss of admitting privileges as well.

If you have had your medical license suspended, you will need to work on getting that reinstated before you can gain admitting privileges again. You may need to complete a waiting period, a substance abuse program, or submit a reactivation application.

One of the ways the government is trying to respond to the urgent national opioid epidemic is by sending the Drug Enforcement Agency (DEA) after practitioners suspected of overprescribing opioids to patients. While there are many doctors who have rightfully been investigated and held responsible for overprescribing opioids, others have gotten caught in the cogs of a machine that is desperately trying to prove that it is doing something - whether that something is actually helpful or not.

Even if you are certain you are not guilty of overprescribing opioids to your patients, it is essential to take an investigation by the DEA seriously. If the Illinois medical board is concurrently conducting a separate investigation, the DEA’s findings may influence that investigation. While you may not have violated any laws regarding opioid prescriptions, the board may be interested in other potential violations, in distancing itself from you for other reasons, or in responding to a complaint that is a result of a personal vendetta. No matter the reason, you need to take an investigation seriously and have a professional license defense attorney’s help.

What Should I Do if I Am Being Investigated by the DEA?

First, of course, you should hire an attorney who can guide you throughout the investigation. Do not speak with investigators, your employer, or anyone else about the investigation until you have first spoken with an attorney who can advise you on what to say. Even speaking with a close colleague or spouse could be risky, as that person could be subpoenaed and asked questions about your conversations.

Standards for doctor-patient relationships are understandably high. Doctors and other healthcare workers are in a position of authority over their patients, and a doctor who is found to have engaged in an inappropriate doctor-patient relationship may be at risk of losing his license. In addition to putting themselves at risk of accusations of medical malpractice, deviating from the standard of care by having even a voluntary relationship with a patient can be an act of negligence by medical professionals. Of course, acts of sexual assault or violence against a patient can similarly result in sanctions against licensure, as well as criminal investigations and punishments.

However, medical practitioners are people and people make mistakes. Furthermore, while practitioners are generally permitted to have consensual relationships with former patients, there may be a question as to whether the professional relationship was legitimately terminated prior to the relationship taking place. If you are a medical professional facing sanctions for allegedly engaging in inappropriate relationships with your patients, contact an Illinois medical license defense attorney for help.

Investigations for Inappropriate Doctor-Patient Relationships

If a doctor is accused of having an inappropriate relationship with a patient and admits to this behavior, it can be very difficult for the doctor to defend himself in an investigation into his conduct. It is, therefore, very important to retain legal representation and to act carefully, especially during the initial stages of an investigation. The investigation will generally follow a standard process:

There are many professions in Illinois that require a professional license. There are boards that oversee the different types of licenses, with most of them falling under the umbrella of the Illinois Department of Financial and Professional Regulation (IDFPR). Each board has their own set of rules and regulations that stipulate what is required and what is forbidden for someone to be approved for their license. One of the factors that could make it difficult for an applicant to obtain a license is if the applicant has been convicted of a crime.

What Type of Criminal Record Will Not Have an Impact on a License Application?

Generally, there are certain types of criminal record entries that should not have an effect on a license application. These include:

• Any arrests and adjudications that occurred when the applicant was a juvenile

  ...

Unfortunately, not all investigations of a professional license holder by the Illinois Department of Financial and Professional Regulation (IDFPR) are resolved with the allegations or complaints dismissed. There are cases where the board will find that the license holder violated a regulation and that some level of discipline is warranted.

In many situations, the professional will enter into some type of settlement agreement with the board that oversees their license (i.e., Illinois Medical Board, Illinois Nursing Board, etc.) in order to be able to continue practicing. But what happens if the license holder is accused of violating the settlement agreement? Does a violation mean an automatic suspension or revocation of a license?

Settlement Agreements

There are a variety of different reasons why a professional would be given the opportunity to enter into a settlement agreement to avoid loss of their professional license. For example, settlement agreements are often used in situations where the board finds there is enough evidence of a substance abuse issue for the license holder. In some cases, the professional may need to comply with daily check-ins either in-house or with one of the many companies that employers can contract with to oversee employee drug testing.

 Making pharmaceutical errors can have a significant detrimental impact on a pharmacy owner or pharmacist. The Illinois Board of Pharmacy and the Drug Enforcement Administration (DEA) can take harsh action, classifying a pharmaceutical error that results in serious injury or death as malpractice. In addition to the civil legal ramifications brought forth by the alleged victim and/or their family, a pharmacist and the facility that employs them can also lose their licenses.

Incorrect Medication to the Patient

If a patient is given the wrong medication, it can cause serious or even fatal side effects. Unfortunately, these mistakes do occur, especially in pharmacies that have a large volume of prescription medications they fill on a daily basis. This can happen for any of the following reasons:

• The medication has a similar name as the name of the medication the patient was supposed to be given. Take, for example, Catapres® (clonidine) and Klonopin® (clonazepam). The generic names for both of these medications are very similar, but if the drugs are mixed up, the patient can experience loss of seizure control, hypotension, and other dangerous side effects.  

  ...

On January 1, 2022, the No Surprises Act (NSA) went into effect. This federal law gives doctors and other licensed health care professionals, medical facilities, hospitals, and insurers significant and often complex regulations that must be adhered to in order to avoid serious sanctions that could include hefty fines and loss of medical licenses.

What Does the NSA Cover?

Lawmakers passed the NSA as a way to protect patients from unexpected medical charges and force providers to be more transparent when it comes to what they are charging. National statistics show that at least 20 percent of patients have received shocking emergency medical care bills with unexpected charges at some point in their lives.

The law limits the amount of liability a patient has on deductibles, copays, and coinsurance they are responsible for if situations prevent them from obtaining services from providers in their health insurance network and they are forced to obtain medical treatment from out-of-network providers at in-network facilities. 

 Our Illinois professional license defense law firm has written many blog posts regarding the types of behaviors and activities that can result in the suspension of a professional license, including insurance fraud, substance abuse, and criminal convictions. But there are also other reasons why the state may take action against your professional license that you may not realize. One of those reasons is if you owe unpaid income taxes to the state of Illinois.

Actions by the Illinois Department of Revenue (IDOR)

Under Illinois law, the majority of residents – with some exceptions – are required to file a state income tax return. Businesses are also required to file state income tax returns, including medical offices and other healthcare facilities.

Your tax return will determine whether or not you owe taxes or if you are entitled to a refund. If you owe the state money but fail to pay when you send your tax return in, the IDOR will send you a bill for the amount you owe. That bill will also show the penalty and interest the state is charging you for not paying your taxes on time.  

In January 2020, the recreational use of marijuana became legal in the state of Illinois. Under the law, anyone over the age of 21 is allowed to cumulatively possess 30 grams of cannabis flower, five grams of concentrate, and cannabis-infused products containing up to 500 milligrams of tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.

But medical professionals are often held to a different standard when it comes to marijuana, even if it is legal. There may not be criminal consequences for using cannabis products, but you could be putting your medical license in jeopardy under certain circumstances.

Using Marijuana Products

If you are a doctor, nurse, or other medical license professional, you may be legally allowed to use marijuana products in Illinois under the following circumstances:

Our professional license defense law firm has written extensively about the serious consequences physicians face if they are accused of medical insurance fraud, including loss of medical license even criminal charges. However, dentists can also be accused with insurance fraud and face the same type of consequences. If you have been accused of dental insurance fraud, contact an Illinois professional license defense attorney right away.

Dental Insurance Fraud

Dental fraud is any intentional misrepresentation or deception of treatment needed in order to obtain unauthorized benefits. According to the National Health Care Anti-Fraud Association, more than $12 billion is lost to dental fraud every year.

One method of fraud that is becoming more common is the alterations of digital X-rays using software programs to create images that show bogus tooth decay, missing tooth structure, lesions, fractures, and more.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) has issued the latest edition of the Health Care Fraud and Abuse Control Program (HCFAC) Annual Report. The report details the collection of just under $1.9 billion in healthcare fraud settlements and judgments in fiscal year 2021. Funds were returned to the Medicare Trust Funds and also to other federal agencies. Per the HCFAC, the federal government was able to recoup more than $5 billion in healthcare fraud.

Healthcare Fraud Charges

The U.S. Department of Justice (DOJ) initiated more than 800 new criminal healthcare fraud investigations last year. Of those investigations, federal prosecutors filed criminal charges against 741 defendants. More than 300 of those defendants have already been convicted of healthcare fraud-related offenses.

According to the report, the COVID-19 pandemic contributed to an increase in the number of healthcare fraud cases that involved unnecessary lab testing, unnecessary services, and fraudulently obtaining pandemic healthcare relief funds.

One of the most serious charges that a physician can be accused of is violating the Controlled Substances Act. Under the Act, doctors are authorized to dispense controlled substances covered under the law by prescription to patients but only under if that medication is provided for a “legitimate medical purpose.” Violations of this law can result not only in a doctor losing their medical license but they could also face a prison sentence if found guilty.

Last month, the U.S. Supreme Court overturned the convictions of two doctors who were convicted in two different cases of unlawful drug distribution. In a unanimous decision, the justices sent both cases back to the lower courts in each case’s respective state.

Accusations of Unauthorized Prescriptions

In the first case, a doctor who ran a clinic in Alabama was accused of issuing almost 300,000 prescriptions for controlled substances in a four-year period. Prosecutors said the clinic was the country’s leading source of fentanyl drug prescriptions.

Our law firm has written a number of blog posts regarding the consequences that can occur with a physician’s medical license should they find themselves facing criminal charges. This is why any type of criminal accusation – even if it is a first offense – should trigger a phone call to a skilled Illinois medical license defense attorney since there is little doubt that the criminal charges will lead to some kind of action by the Illinois Medical Board.

Self-Reporting

Although your first instinct may be to try to keep the news of your arrest as quiet as possible, Illinois physicians have a responsibility to self-report certain types of arrests and/or convictions to the medical board. Medical facilities also have an obligation to report any information they learn about a physician affiliated with their organization who is facing certain charges or has been convicted. So, if the doctor fails to self-report, there is a high risk the hospital or medical facility they work for could, compounding an already potential dire situation with the medical board.

Crimes of Moral Turpitude

The majority of criminal convictions that could lead to a loss of medical license involve felony convictions. However, there are certain misdemeanor crimes that can also have the same result. These are referred to as “crimes of moral turpitude.”

The Drug Enforcement Administration (DEA), which was established in 1973, is the federal agency that is responsible for the enforcement of laws and regulations related to narcotics and controlled substances. Pharmacies and other businesses that administer, dispense, or supply controlled substances are required to register with the DEA.

Periodically – and at random – the DEA will conduct an inspection of a pharmacy in order to ensure the pharmacy is compliant and following required regulations under the Controlled Substances Act (CSA). These inspections – referred to as audits – typically take place every three years or so. However, there are situations where the DEA may decide to conduct an audit, such as receiving information of potential irregularities.

If you have been notified that your pharmacy is under a DEA audit, the following steps can help you prepare.

In 1986, Congress passed the Title IV of Public Law 99-660, the Health Care Quality Improvement Act. Included in the law was the establishment of the National Practitioner Data Bank (NPDB), which serves as a federal repository of health care providers in the U.S. The law requires reporting of any hospital, licensure, or professional society actions against doctors, dentists, and other healthcare professionals. It is important for any healthcare professional to be aware of the NPDB and what may be required of them.

What Type of Information Is Reported to the NPDB?

Under the law, the following information is required to by reported to the NPDB by specific health care entities:

• Any medical malpractice payments made on a healthcare professional’s behalf, including out-of-court settlements

  ...

Last 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.