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Provider Enrollment Termination and Reinstatement Services

Illinois Attorneys Helping Healthcare Providers and Pharmacists Maintain Provider Status

For those who provide healthcare services, the ability to maintain contracts with insurance companies is an essential part of doing business. Anything that threatens these contracts is likely to have a significant negative impact on a person's career. If you are facing the loss of provider status or the suspension of your professional license, the Law Offices of Joseph J. Bogdan, LLC can help you determine your legal options and work with you to protect your practice or pharmacy.

What Is Provider Enrollment?

Provider enrollment is applicable to healthcare providers and/or entities such as pharmacies that provide healthcare services. It includes enrollment in Medicaid, Medicare, and private insurance plans. Providers can provide care to patients that are insured through insurance plans of these entities and can bill the plans for services provided to the beneficiaries. Once enrolled, providers can be terminated from the insurance plans for various reasons, such as providing substandard care, fraudulent billing, addictions, and non-adherence to insurance provider contract terms.

Most private insurance contracts contain provisions that allow the insurance company to terminate the provider contract if the provider's license is restricted by a state or federal agency. In many cases, after a healthcare professional's license is placed on probation or suspension, the insurance companies will send notice of an intent to terminate the contract. In addition, criminal convictions that relate to the provider's practice - particularly, convictions related to billing fraud - will also threaten a provider's ability to maintain their insurance contracts.

How Can My Provider Enrollment Be Reinstated?

The key to reinstatement with private insurers is to show rehabilitation with the Illinois Department of Financial and Professional Regulation (IDFPR). If you can show that the restrictions on your professional license have been lessened or removed and that you are legally eligible to return to normal practice, your status as a provider may be reinstated.

If you have received a notice of intent to terminate your contract with a private insurance company, if you are facing exclusion from providing care or services to Medicare and/or Medicaid patients, or if you are concerned that potential discipline to your professional license may threaten your provider status, the Law Offices of Joseph J. Bogdan, LLC can provide the legal help you need. We help healthcare providers get back into provider status with private or public insurance plans, and we assist in the defense of professional licenses, including for those who are facing discipline by the Illinois Medical Board, the Illinois Board of Nursing, and the Illinois Board of Pharmacy. Contact our office at 630-310-1267 to set up a free consultation today.

CMS Services for Medicare and Medicaid Exclusion and Reinstatement

Illinois Pharmacist License Defense Attorney

For many healthcare providers and pharmacists, the ability to provide services to Medicare and Medicaid patients is essential. However, an audit by the Centers for Medicare and Medicaid Services (CMS) can threaten a provider's ability to continue offering care to a significant percentage of patients. If you are facing CMS exclusion, the Law Offices of Joseph J. Bogdan, LLC can help you understand your options and work with you to protect your professional license and your practice or pharmacy.

What Is CMS Exclusion?

CMS services apply at both the state and federal levels. They are responsible for overseeing the money paid to Medicare and Medicaid. CMS regularly performs audits of healthcare providers and entities such as pharmacies, and information uncovered during these audits may result in a provider or entity being excluded from providing care or services to Medicare and/or Medicaid patient beneficiaries. Exclusion can be the result of fraudulent billing, poor patient care, and diversion of or addiction to controlled substances. A CMS exclusion is typically a very serious problem for a healthcare professional, often resulting in the suspension of the professional's license.

How Can an Attorney Help?

Fortunately, there is a legal process to remove a healthcare provider or an entity such as a pharmacy from CMS exclusion. At the Law Offices of Joseph J. Bogdan, LLC, we understand how to complete this process successfully, helping you avoid this threat to your business and professional license. We will work with you to cooperate with CMS and prepare thorough, detailed explanations for all of the patient care you provided. We will also help you collect mitigating information and present that information persuasively to IDFPR prosecutors to help prevent the suspension of your professional license or minimize the duration of a suspension.

In addition to practicing law, Attorney Joseph Bogdan has a Pharmaceutical Doctorate degree and is a registered pharmacist. He is a board member of the Illinois Pharmacist Association, teaches pharmacy law at multiple universities throughout the Chicago area, and regularly serves as an expert witness in legal cases related to pharmacies. With this level of knowledge, he understands the issues affecting pharmacy practice, and he will work with you to determine the best ways to assist in defending against CMS exclusion and the suspension of your pharmacist license. If you need skilled legal guidance, contact our office today by calling 630-310-1267 to schedule a free consultation.

How Can an Attorney Help With My IDFPR Formal Hearing or Informal Conference?

License Defense Attorney For Illinois Department of Financial and Professional Regulation Cases

If you have been informed that you are under investigation by the Illinois Department of Financial and Professional Regulation (IDFPR), then the first thing you should do is contact an attorney who is experienced in defending professional licenses. If the IDFPR decides to proceed with a case against you, you will be provided with notice from an IDFPR prosecutor about either a formal hearing or an informal conference. When you work with the Law Offices of Joseph J. Bogdan, LLC, we will ensure that you are treated fairly throughout the process and work to help you reach the best possible resolution to your case.

When representing you in an informal conference or formal hearing, we will take the following steps:

1. Educate You About the Process and the Possible Outcomes

A formal hearing will be held before an administrative law judge, and it will be similar to a hearing in a criminal or civil courtroom. On the other hand, an informal conference usually takes the form of a private meeting between you, the IDFPR prosecutor, and one or more members of the applicable licensing board, such as the Illinois Board of Nursing, the Illinois Board of Pharmacy, or the Illinois Dental Board.

As you prepare for your hearing or conference, we will discuss the possible outcomes with you, ensuring that you understand the strategies for achieving the best possible resolution to your case. We will work with you to collect supporting materials and witnesses, help you understand how to communicate your story effectively, and ensure that IDFPR maintains your right to due process throughout the course of your case.

2. Help Present Your Case in the Most Effective Way Possible

With our experience assisting with IDFPR professional license defense cases, we can determine the most effective strategy to take in your hearing or conference. When preparing to present your case, we will assist with the collection and presentation of exculpatory evidence. In the best-case scenario, we can obtain witness testimony or documentation that clearly disproves the allegations against you. Unfortunately, that evidence is not as common as one would hope. If this type of evidence is not available, we will gather a range of witnesses (including experts) who can testify on your behalf and obtain documentation that can help fill in the "gray areas" that exist in nearly every case. By providing a complete picture of your professional practices, we can demonstrate why you deserve to continue holding a license and practicing your chosen profession.

3. Prepare You for Questions During Your Hearing or Conference

During a formal hearing, you will receive questions from the IDFPR prosecutor, and during an informal conference, you will be asked questions by the attending board members. We can help you be ready for the types of questions you can expect and how best to respond to them. In many cases, the questions will begin with a review of your education, training, and work experience before moving on to questions about the specific allegations made against you. Your answers to these questions are your chance to offer an explanation of what happened and provide comments about specific details mentioned or claims that were made. With proper preparation, you can have the right answers ready and avoid being surprised by unexpected questions or claims.

4. Protect Your Right to Continue to Practice in Your Respective Field

At the Law Offices of Joseph J. Bogdan, LLC, we will work to collect all of the facts about your case by speaking with all witnesses (including those whose stories may be unhelpful to your case) and securing all relevant documentation. With all of this information and testimony, we can determine how to present information in the best possible light. We will fight to protect your due process rights, ensuring that the IDFPR attorneys are held accountable to their burden of proof. With our help, you can achieve a positive outcome to your IDFPR case, ensuring that you can continue to practice your chosen profession. To schedule a free consultation with us and begin the process of defending your professional license, contact our office today at 630-310-1267.

Can I Receive a Professional License if I Have a Criminal Record?

Illinois Attorney for IDFPR Law

For many people, a professional license is necessary to work in their chosen field. However, some may wonder about the ability to receive or maintain a license if they have a criminal arrest or conviction on their record. When determining how a criminal record may affect your eligibility for a professional license, it is important to work with an attorney who is experienced in this field of law. At the Law Offices of Joseph J. Bogdan, LLC, we can help you understand your rights and advocate for your ability to hold the license you need.

How Will a Criminal Conviction Affect My Professional License?

If you have a criminal record, your ability to receive a license will depend on the nature of your past crimes. By law, the Illinois Department of Financial and Professional Regulation (IDFPR) is obligated to permanently deny or revoke a healthcare provider's license based upon certain criminal convictions. In many instances, the IDFPR has the discretion to issue or deny a license based on the nature and types of past criminal convictions. Certain violent and sexual crimes will cause someone to be permanently barred from obtaining or maintaining a professional license. All other crimes are matters for the licensing boards that may result in serious public disciplines. However, with proper representation, severe discipline can often be avoided, and even "permanent" bars can be submitted for review periodically.

When determining whether to revoke or deny a license, the IDFPR will consider a number of factors. The amount of time that has passed since the conviction is one important factor. Other important factors include whether you self-reported the conviction to the Department, the seriousness of the underlying criminal conduct, whether the conviction is related to your professional practice, and the measures you have taken to rehabilitate yourself.

Many professionals with criminal convictions will eventually seek to have their criminal record expunged after serving their sentence and completing any court-ordered requirements. If you are successful in having your conviction expunged, you will have no duty to report the expunged conviction to the IDFPR on a license application or a license renewal. In addition, if you were disciplined by IDFPR because of a conviction, and that conviction is expunged, you may file a request to have the disciplinary action taken off your record as well.

How Can an Attorney Help Defend My License?

In most cases, an attorney experienced in the area of IDFPR law can assist in negotiating for the issuance of a professional license, even if a criminal conviction exists. At the Law Offices of Joseph J. Bogdan, LLC, we have a great deal of experience helping those with criminal convictions make their case to the IDFPR. We will collect as much information about the underlying criminal conduct as possible, and this will help us determine what information prosecutors or an administrative law judge will find persuasive when arguing that you should be able to continue practicing. Some important factors to consider include whether you self-reported your conviction, whether you have shown rehabilitation, and the amount of time that has passed since the conviction.

With our help, you can make the case that your criminal conviction should not affect your ability to practice your profession, ensuring that you are able to receive or maintain the license you need. Contact us today at 630-310-1267 to arrange a free consultation.

Can a DUI Jeopardize My License as a Medical Professional?

Illinois Medical License Defense Attorney

Being arrested for drunk driving is an intimidating experience for anybody. A DUI conviction can result in serious fines, potential jail time, probation, and the loss of your driver's license. Even an arrest for DUI that does not result in a conviction can lead to a driver's license suspension, and it can have a negative impact on your personal and professional reputation. To make matters worse, your professional license may also be affected. That is why it is essential for anyone in this situation to work with the professional license defense attorney at the Law Offices of Joseph J. Bogdan, LLC.

How Can My Medical License Be Affected By a DUI?

If you are a healthcare or medical professional who is arrested for Driving Under the Influence (DUI), you will likely face a vigorous investigation and prosecution by the IDFPR, and this can have a significant effect on your ability to practice your profession. While there is no specific formula for assessing penalties after a DUI arrest or conviction, more often than not, you will face public discipline like probation or suspension of your medical license. In fact, even if you are able to avoid a criminal conviction, you may face discipline based on the facts surrounding the DUI, such as the blood alcohol content (BAC) level measured after you were arrested.

What Type of Discipline Will I Face?

In many cases, disciplinary action takes the form of a license suspension. Suspensions of a professional license can be definite or indefinite. A definite suspension will terminate after a specified amount of time, while an indefinite suspension will remain in effect until you successfully petition for restoration of your license. In some cases, an indefinite suspension has a minimum period of suspension, but if there is no minimum period of suspension, a licensee is able to petition for restoration immediately. However, before doing so, you should take the proper rehabilitative measures, such as seeking necessary clinical treatment for substance abuse, completing any requirements imposed by a criminal judgment, and taking any relevant continuing education coursework.

Contact an Illinois Medical License Defense Lawyer

If you have been arrested for DUI, your license as a medical professional may be in jeopardy. An attorney familiar in the field of professional license defense can help work up your case and prepare an appropriate defense. This includes coordinating with the attorneys handling your criminal matter and protecting your license from being unfairly disciplined. To learn more about how the Law Offices of Joseph J. Bogdan, LLC can provide you with representation when you are facing disciplinary action, contact us at 630-310-1267 to schedule a free consultation.

Illinois State Bar Association DuPage County Bar Association Illinois Pharmacists Association American Pharmacists Association 10.0Joseph John Bogdan
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