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Violations of the Stark Law
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.
PBM Audits for Black-Market Diabetic Test Strips
In the healthcare industry, pharmacy benefit managers (PBMs) serve a pivotal role. In fact, a pharmacy would be unable to operate without having a contract with a PBM. The PBM serves as an intermediary between the pharmacy and the insurance company, negotiating rates and processing the majority of all prescriptions.
Under these contracts, the PBM also has the right to conduct an audit of the pharmacy to make sure that all terms of the contract and proper guidelines are being met. Any discrepancies found during the audit could result in not only the pharmacy being required to pay back funds they have received, but could also result in the PBM contract being terminated. One product PBMs have been laser focused on recently is the number of pharmacies purchasing diabetic testing strips from unauthorized sources.
Black Market Diabetic Testing Strips
There are currently more than 30 million patients diagnosed with diabetes in this country. Patients who have the condition are required to test their glucose levels each day. One of the most common ways to test is by using diabetic test strips. It is so common revenues from these test strips surpasses $8 billion a year.
Illinois Creates New License Process for Midwives
Over the past few decades, the experience of labor and delivery for women has undergone dramatic changes. The process used to be a very clinical one, ending in a birthing experience that involved drugging the mother from the moment she arrived at the hospital and keeping the newborns in the nursery instead of with their mothers for the majority of their extended hospital stays.
The attitude about the birthing process has all changed to a much more family-intimate experience. This has also led to many women choosing to entrust their care to midwives instead of obstetricians. Some women even decide to have their babies born at home, whether by choice or because of the astronomical expense of a hospital delivery.
However, until recently, only those who were certified as nurse-midwives could provide Illinois women with this type of care, but a new law recently signed by the governor will create a new license process for midwives that does not require a nursing degree.
Do Medical Professionals Have to Report Arrests to Medical Boards in Illinois?
No matter where you are in life or what your profession is, anyone can find themselves dealing with some kind of legal issue, whether it has to do with being charged with a DUI, stealing medications, fraud, or domestic violence. While these criminal accusations are serious for any individual, they can have even more dire consequences for an individual who holds a professional license. If you are a licensed professional in the state of Illinois and have concerns or questions regarding what you are required to notify the licensing board that oversees your profession, you should speak with an Illinois professional license defense attorney.
What Charges Need to Be Disclosed?
When a person who holds a professional license is charged with a crime, one of the first factors that need to be examined is whether the crime is related in any way to their profession. In the case of a medical professional stealing prescription medications from patients, that relation is pretty clear. There are other charges that are not so clear. For example, if a doctor is arrested for drunk driving, they may not feel this is something they need to report because it was not connected to their position.
Can My Social Media Posts Put My Illinois Nursing License in Jeopardy?
Social media platforms have become an integral part of many people's daily lives, often without realizing just how integral. People post photos, comments, opinions, and memes on Facebook, Instagram, Twitter, SnapChat, and several other sites on a regular basis. While social media is often a good place for keeping in touch with family and friends, and even networking, it is crucial to be vigilant about what you are posting, especially if you work in certain fields, such as nursing. In fact, items from your social media posts could ultimately be used against you in any actions taken against you by the Illinois Board of Nursing.
Conduct That Is Unprofessional
Many of us have had the unfortunate experience of having someone tag us in a photo that we think we look horrible in. It is now out there for everyone to see. However, if you are tagged in a photo that also shows you engaging in behavior that may be considered inappropriate or unprofessional, the photos can be used as evidence against you as ground for any disciplinary action by the state nursing board.
Do I Need an Attorney to Defend My Professional License Against a Complaint?
In Illinois, there are a number of different professional licensing boards that all fall under the umbrella of the Illinois Department of Financial and Professional Regulation (IDFPR). Any individual who holds a professional license in the state of Illinois is under the oversight of whatever board issued that license. When there is a complaint or other issue filed against an individual, that board will be the one to investigate the complaint, determine if there is validity to it, and decide if any disciplinary action should be taken against the person who holds that license.
Anyone who has been notified that they are under investigation should contact an Illinois professional license defense attorney right away in order to ensure their rights are protected in any investigation and/or hearings that take place. Choosing the right attorney, however, is critical.
What Happens When an Employer Files a Complaint with the Illinois Medical Board?
Not every job turns out the way we hope. It is not uncommon for a medical professional – just like any other profession – to find themselves at odds with their supervisor or manager. Although many of these disagreements may be worked out, there are unfortunately instances where no resolutions are able to be met and the employee either leaves or is fired. In extremely acrimonious situations, the employer may even make accusations of wrongdoing against the employee and threaten or actually file a complaint with the Illinois board that oversees that medical professional’s license. If you find yourself in this position, contact an Illinois medical license defense attorney right away for legal assistance.
Reporting Misconduct of an Employee
If an employer believes that one of their employees has committed some kind of act or behavior that violates the standards set forth by the state of Illinois, their employer not only has a right to report that violation, but they also have a legal duty.
Steps to Take to Protect Your Illinois Nursing License
Nurses are a special breed of people. They dedicate their lives to taking care of others, often at the expense of time spent with their own loved ones. To become a nurse, they spend several years going to school and training and continue that education during their careers to stay abreast of the most up-to-date medical care for patients and meet the requirements of the Illinois Board of Nursing. Given the amount of dedication and sacrifice a nurse pours into their career, it is imperative to take all the necessary steps to ensure their nursing license is protected. All it takes is one false or misleading allegation, and a nurse can find themselves facing disciplinary action or even loss of their nursing license.
Complaints that May Lead to a Nursing License Investigation
The Illinois Board of Nursing is tasked with overseeing all licensed nursing professionals in the state. A complaint made to the board will trigger an investigation into whether the allegations being made are true and – if they are – what disciplinary action is warranted. Any nurse who is notified by the board that there has been a complaint filed against them should contact an Illinois professional license defense attorney right away.
Are You Facing Allegations of Telehealth Fraud in Illinois?
Last year, as the COVID-19 pandemic hit and the country went into lockdown, one of the many changes that were implemented was how doctors and other healthcare providers saw patients. Instead of in-person appointments, patients consulted with their physicians via telehealth video calls. Although much of the country has opened up, many doctors are still using telehealth for appointments. However, along with this newer technology comes new opportunities for healthcare billing fraud. It can also leave healthcare providers unknowingly committing a crime that can result in criminal charges and loss of their medical license.
Telehealth Expansion
Telehealth uses video technology to connect doctors with their patients for medical checkups. This technology allows patients to communicate with their doctors any medical concerns they have and allows doctors to provide medical advice and treatments, without the risk of exposing either party to COVID. While telehealth has been used for years in rural areas or areas where there are no nearby healthcare providers, its use has become very widespread throughout the country during and post-pandemic.
Defending Against Accusations of Patient Abandonment in Illinois
When you own or are part of a medical practice, you may have long-term patients who have been coming to you for their healthcare needs for years. You may also have patients who are only short-term – maybe they move away and that means changing physicians, or your practice is no longer covered under their health insurance plan, or maybe they just decide to change doctors. However, there may be the occasion where you yourself decide you need to end a relationship with one of your patients. While you may think that you have every right to choose who you take on as patients and who you do not, how you terminate a patient relationship may result in accusations of patient abandonment.
Terminating a Patient
There are a number of valid reasons why a doctor may make the decision to end a relationship with a patient:
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