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How Can a Medical Provider Avoid Being on the OIG Exclusion List?
Around 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.
Steps You Can Take to Avoid Losing Your Medical License
Doctors, 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.
How Should Healthcare Providers Respond to OIG Investigations?
For 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.
Should I Voluntarily Surrender My DEA Registration?
For 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.
How Can a Pharmacy Qualify for DMEPOS Accreditation?
Pharmacies 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.
Can Chiropractors Face License Discipline Based on Malpractice Claims?
Chiropractors 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:
How Can I Defend Against the Loss of Medical Board Certification?
Doctors 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.
What Should I Do if I Receive a DEA Notice of Inspection?
Medical 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.
How Managing the Pain of Patients Can Place the License of Nurse Practitioners at Risk
Opioid 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.
The Federation of State Medical Boards: What It Is and Why Physicians Should Care
Most 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.
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