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

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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.

It 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.

In 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.

It 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:

In 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.

The 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:

In 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:

In 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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According 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.

In 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:

There 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.

There 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.