In the healthcare industry, there are many safeguards put in place to protect patients. When it comes to medication and pharmacies, it is no different. PBM pharmacy audits are conducted both for the sake of the pharmacy benefit manager (PMB) and for you, the pharmacy owner. A PBM audit can be a stressful experience for a pharmacy, especially a small, independent one, but many pharmacies cannot operate at desired capacity without also working with a PBM. If you have an upcoming PBM pharmacy audit, proper preparation is key to success.

Documentation is Extremely Important

For many pharmacies, but especially independent pharmacies, documentation is often an area that needs attention. When your PBM auditor comes to your pharmacy, they may request to see certain documentation that could be from months or even years ago. This documentation could be anything to do with things such as supply changes, such as going from a 30-day supply to a 60-day supply, or early refills. Having your documentation completed, thorough, and organized will save you much stress during the audit.

Consistency Is Expected

Part of the job of a PBM auditor is to make sure that each patient receives the same standard of care when they use your pharmacy. This is accomplished by making sure that all employees are following the same rules and policies while they perform their job. When your PBM auditor is at your pharmacy, they will be looking for any errors made by your staff, such as checking the amount of medication dispensed or ensuring all of the proper forms and documentation are filled out. It is a good idea to have an official standard operating procedure (SOP) written out and distributed to all of your employees so that they understand what is expected of them every time they fill a prescription.

In many ways, nurses are integral to a properly-functioning healthcare system. Nurses play an important role in patient care, especially because they are usually the ones who spend a majority of time with the patient. One of the tasks that nurses perform is documenting a patient’s history and medical care, also known as charting. Charting is an essential part of a nurse’s job and mistakes on a chart or an incomplete chart could result in injury or harm to the patient or in some cases, even death. Because of this, your nursing license could be at risk if you make a charting error. If you face disciplinary action related to a charting or documentation error, you should speak with an Illinois nursing license defense lawyer.

Common Documentation Errors

Proper charting and patient documentation are crucial for not only the patient’s health and safety, but also for your sake. Charting errors can lead to a slew of issues such as improper treatments, lack of treatment, permanent damage or even death to a patient. If a malpractice or other legal suit is filed pertaining to your patient and it was discovered that you made an error when you were charting, you could face serious consequences.

Charting and documentation errors can come in many different forms. Even though nurses are not the only ones responsible for a patient’s care, they are typically the ones who have the most contact with the patient and therefore usually have much responsibility for the patient’s wellbeing. One simple charting error could be the end of a nursing career. The most common charting errors include:

In the state of Illinois, there are hundreds, if not thousands, of people who have careers as licensed professionals. These professions can range from the obvious, such as doctors and nurses, to the not-so-obvious, like architects and engineers. The one thing that all of these careers have in common is the need to become licensed in the state they practice. The state of Illinois has also put into place certain requirements for license renewal for many professions, one such requirement is continuing education. This requirement exists for the sake of maintaining a knowledgeable and up-to-date workforce. One such profession that requires continuing education is social work.

Understanding Social Work Licensure

In Illinois, there are two types of licenses you can receive in the social work profession: a licensed social worker (LSW) and a licensed clinical social worker (LCSW). These two types of licenses are very similar, though they have separate qualifications and requirements, mostly depending on your experience as a social worker. No matter the type of license, social work licenses expire on November 30 of every odd-numbered year. Despite these differences, the continuing education requirements are the same for these licenses.

Maintaining Continuing Education Requirements for Social Workers

The first time a social worker goes to renew their license, they do not have to have completed any continuing education requirements, though they must still submit an application for renewal. The second time a social worker renews their license, they must certify that they have completed 30 hours of continuing education. These 30 hours of education must be related to the practice of social work but they must also consist of:

In the state of Illinois, many different professions are regulated by the Illinois Department of Financial and Professional Regulation (IDFPR), from architects and detectives to accountants and engineers. Nearly all medical professionals, including psychologists, are also licensed by the IDFPR and must meet certain requirements to legally practice in the state. These requirements are put in place in order to maintain a certain level of safety for the public. Illinois issues two types of licensure for psychologists: clinical psychologist and prescribing psychologist. Each type of license has its own requirements, which are important to understand if you plan to apply for a license.

Clinical Psychologist

A clinical psychologist can be found in a variety of settings. Many clinical psychologists have their own practices and see various types of patients about various issues. Clinical psychologists have the ability to diagnose and treat patients with a variety of issues and work with primary care physicians and psychiatrists to control patients’ conditions with medication. To become a licensed clinical psychologist in Illinois, you must:

• Be at least 21 years old
• Be a graduate of a doctoral program that is accredited by the American Psychological Association
• Complete a minimum of two years of supervised experience, one of which being an internship and the other being postdoctoral experience
• Pass an examination given by the IDFPR
• Provide all of the required documentation, including proof of completion of required education and work experience

Prescribing Psychologist

A prescribing psychologist is a clinical psychologist who is permitted to prescribe certain medications to his or her patients. Because prescribing psychologists are given this ability, they must meet different requirements than the ones set forth for clinical psychologists. To become a licensed prescribing psychologist in Illinois, you must:

Though not as much as a physician, it often takes years of schooling and studying to become a nurse. All of that hard work finally culminates when you apply to receive an Illinois nursing license that enables you to practice in the state of Illinois. If you are a nurse, you are held to certain standards, which if broken, can result in disciplinary action. The Illinois Department of Financial and Professional Regulation (IDFPR) is the licensing body that oversees all nursing, physician, pharmacist, psychologist and chiropractic licenses, among many others. The IDFPR is also the disciplining body that will take action against your license if you are accused of wrongdoing.

Cause for Disciplinary Action

There are a number of reasons why a nurse could face disciplinary action against his or her license. These reasons include behavior such as “unethical or unprofessional conduct,” or being convicted of a crime. Here are a few common reasons why you may find yourself facing disciplinary action against your license:

• Being convicted of any crime that is a felony or misdemeanor and contains an essential element of dishonesty or is directly related to the nursing profession
• Behavior that demonstrates the incapacity or incompetence to safely and lawfully practice nursing
• Violating any rules stated in the Nurse Practice Act
• Engaging in dishonorable or unethical conduct that is likely to harm the public
• Unlawful taking, selling, distributing or manufacturing of any drug or narcotic
• Excessive use or addiction to alcohol or narcotics that prevents the safe practice of nursing
• Sexual abuse, sexual misconduct or sexual exploitation of a patient
• Failing to provide information or purposefully providing false information to the IDFPR
• Failing to report a suspected case of child abuse or neglect

Types of Disciplinary Action

If you have been accused of any of the above violations, the IDFPR has probably gotten into contact with you about disciplinary actions. There are a number of actions that could be taken against your license. These include:

Most people know that a person’s medical records and information are private information that is protected by law. If you are a medical professional, you must be familiar with the Health Insurance Portability and Accountability Act (HIPAA), a law that was passed in 1996 to protect the privacy of patients’ health information in the United States. The law gives rules and procedures that you must follow in order to protect your patients’ privacy rights. If you fail to follow HIPAA procedures or rules, you could face expensive fines and your medical license could even be put into jeopardy. Here are a few of the most common ways HIPAA is violated.

Unauthorized Access of Healthcare Records

The HIPAA only gives certain reasons as to why you can access the healthcare records of a patient without gaining their consent. Unless you are accessing records for treatment, payment or healthcare operation, you are doing so illegally. This can result in disciplinary action and a fine to the organization is possible, though uncommon.

Not Performing a Risk Analysis

One of the most common HIPAA violations to result in a financial penalty is given to organizations that fail to perform a risk analysis. These analyses must be performed regularly in order to assess whether or not there are any vulnerabilities to the confidentiality and integrity of patient health records. To prevent this from happening, conducting a regular risk analysis is recommended.

Social workers are all around us -- they can be found in schools, hospitals, mental health clinics, the military, private corporations and even in private practices. The purpose of social work is to help people and promote overall well being, which is why social workers are licensed and regulated in the state of Illinois by the Illinois Department of Financial and Professional Regulation (IDFPR). Illinois provides two options for licensure in the state: licensed social worker (LSW) and licensed clinical social worker (LCSW). These licenses are similar, but there are limitations on what each type of license permits a person to do, which is also why the requirements for each license are different.

Licensed Social Worker

If a person holds an LSW, they are permitted to practice social casework, social group work, community-based social welfare, social work education or social work research. LSWs are permitted to administer social services to individuals, groups or communities, along with engaging in clinical social work, as long as it is not conducted in a private, independent practice.

To obtain an LSW, a person is required to:

Throughout the United States, hundreds of physicians are accused of misconduct each year. Many of these complaints are founded on false or inaccurate claims. Regardless of whether or not the claim of misconduct was founded on a false accusation, a physician can lose medical staff membership and privileges. If an accusation of misconduct is deemed serious, you could face a medical license review from the Illinois Department of Financial and Professional Regulation (IDFPR). In the event of a misconduct accusation, seek out the help of a legal professional immediately.

Common Physician Mistakes

When a physician makes a mistake, the error can have major impacts on a patient’s health. Due to this, hospitals hold all of their employees to incredibly high standards. Below are some of the most common errors that can cost a physician hospital privileges.

Mistreatment of Other Hospital Employees: Many misconduct complaints are placed due to abuse of co-workers. If you yell or verbally abuse a fellow hospital employee, you are likely in violation of hospital policy. If you are unwilling to accept criticism from coworkers or speak to other employees in a derogatory manner in the aftermath of a mistake, you could face a misconduct claim. It is important to note that any inappropriate or abusive conduct in the presence of a patient, is likely to lead to a medical license review.

Throughout the United States, thousands of people dedicate their lives to clinical psychology and social work. From psychological or mental health counseling to rehabilitation counseling, in the state of Illinois, these professionals are only able to operate within the state after receiving a certified license from the Illinois Department of Financial and Professional Regulation (IDFPR). If a psychologist or social worker is accused of some form of misconduct, it is likely that they could face some form of discipline or license revocation. If you face an investigation from the IDFPR, it is critically important to seek out legal guidance, as soon as possible.

Misconduct in Illinois

Every year, the IDFPR conducts thousands of investigations to look into cases of potential misconduct. Common forms of clinical psychology and social work misconduct, include:

• Sexual Harassment or Misconduct: According to recent studies, approximately 12% of all mental health professionals admit to having had some form of sexual contact with a patient. In all likelihood that number is much lower than the true percentage of sexual misconduct cases within various psychological professions. Even a consensual sexual relationship with a patient constitutes sexual misconduct and could result in an investigation.
• Confidentiality Agreement Violations: Mental health professionals are bound by federal or statewide confidentiality agreements. Violating confidentiality agreements is a direct form of unethical behavior and misconduct. These violations constitute a breach of contract that professional has with his or her patient, and can lead to a license revocation and further legal consequences.
• Unethical Conduct: Other common forms of unethical conduct among mental health professionals include the unwillingness to meet with a patient in crisis, the scheduling of unnecessary meetings for insurance payment, and the intentional misdiagnosis of mental health conditions. If you have been accused of any of these forms of unethical conduct, contact a legal professional right away.

Contact a Clinical Psychologist Defense Lawyer in Illinois

If you are contacted by the IDFPR regarding a potential a complaint investigation, it is important to inform your attorney as soon as possible. A qualified attorney can help you move forward during the investigation process, and decide whether a settlement acceptance or a hearing in front of an administrative law judge is the best option for your career. Attorney Joseph J. Bogdan has years of experience helping those involved in complaint investigations and is dedicated to protecting the careers of his clients. To set up a meeting with an Illinois professional license defense attorney, call us today at 630-310-1267.