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How Can I Restore My Medical License After IDFPR Disciplinary Action?
There are multiple reasons why medical professionals may face disciplinary action. Certain types of criminal convictions, accusations of medical malpractice or unethical practices, or the loss of a DEA controlled substance registration are just a few of the many issues that may result in discipline. In these cases, the Illinois Medical Board, the Illinois Board of Nursing, or another division of the Illinois Department of Financial and Professional Regulation (IDFPR) may perform an investigation and pursue disciplinary action. Those who have had their medical license suspended or revoked or who have faced other forms of discipline will need to understand their options for restoring their license and resuming their practice.
Types of Disciplinary Action
What Happens During an IDFPR Investigation of a Doctor?
For medical professionals, few things can be as worrisome as the possibility that they could lose their medical license. If you have been notified that you are being investigated for potential license discipline by the Illinois Department of Financial and Professional Regulation (IDFPR), you will most likely be concerned about how this will affect your ability to maintain your license and continue practicing medicine. In these situations, doctors will need to work with an attorney to gain an understanding of the procedures followed during a case before the Illinois Medical Board and the steps they can take to protect against the loss of their license.
Potential Changes to the Rules for DEA Administrative Hearings
Medical providers who prescribe or dispense controlled substances are required to maintain a registration with the Drug Enforcement Administration (DEA). If the DEA believes that a person has acted unlawfully when prescribing or dispensing controlled substances, it may take action to suspend or revoke a provider’s registration. In these cases, a provider can request an administrative hearing where they can present evidence showing why their registration should not be suspended or revoked. Those who need to address these issues will want to be aware of some potential rule changes that could affect administrative hearings in the future.
Proposed Rule Changes by the DEA
What Happens During a Medicare/Medicaid Audit of a Medical Provider?
Most medical providers, including doctor’s offices, hospitals, pharmacies, and other types of medical professionals, provide services to patients and accept payments through Medicare or Medicaid. Providers must meet a variety of requirements when doing so, and the Centers for Medicare and Medicaid Services (CMS) is tasked with ensuring that providers are in compliance. CMS may conduct audits of providers based on billing irregularities, issues related to record-keeping, or other concerns about potential noncompliance. During these types of audits, providers will want to understand the process that will be followed and the requirements they must meet. Failure to comply with CMS requirements or cooperate during an audit could result in the provider being excluded from providing services through Medicare or Medicaid.
Steps Followed in a CMS Audit
The Medicare/Medicaid audit process has four phases:
When Can Disciplinary Issues Lead to a Loss of Hospital Privileges?
For many medical professionals, including doctors, surgeons, nurses, and physician assistants, the ability to provide services for patients in hospitals is crucial to their practice. Whether a person is a full-time staff member at a hospital or has courtesy privileges or surgical privileges, being able to see and treat patients at the hospital will ensure that they can provide quality medical care. This means that medical professionals will want to be aware of any issues that could lead to the loss of hospital privileges. By defending against this form of discipline, providers can avoid issues that may affect their medical license and their overall career.
Reasons for Loss of Hospital Privileges
In some cases, a person may face discipline to their hospital privileges due to issues involving the hospital. Accusations of substandard patient care or malpractice that occurred at the hospital may cause the hospital’s review board to take disciplinary action. These actions may involve a limitation on a person’s privileges, a temporary suspension of privileges, or a permanent revocation of the ability to see and treat patients at the hospital.
How Can Medical Professionals Avoid Accusations of Drug Diversion?
Doctors, nurses, pharmacists, and other medical professionals can face a great deal of scrutiny as they provide services to patients, especially when they prescribe or dispense controlled substances. In some cases, a professional may be accused of drug diversion, in which controlled substances are provided to patients for non-medical purposes or allowed to be illegally sold or delivered outside of the medical supply chain. Drug diversion is a serious offense, and it may lead to the suspension or revocation of a provider’s DEA registration, as well as the loss of a medical license, criminal charges, and other penalties. To avoid these types of consequences, medical professionals will want to make sure they are following the correct policies and procedures regarding controlled substances.
When Can Criminal Charges Lead to the Loss of a Professional License?
Licensed professionals invest a great deal of time, money, and effort to obtain the necessary education and training to practice in their chosen profession. After meeting all the requirements to obtain a professional license, a person will want to make sure they can maintain their license and avoid any issues that could affect their ability to continue working. Professionals should be aware that certain types of criminal convictions could lead to disciplinary action, and they will want to work with an attorney to address these issues and avoid the loss of their license.
Criminal Convictions That May Lead to License Suspension or Revocation
The Illinois Department of Financial and Professional Regulation (IDFPR) oversees licensed professionals, and it may choose to pursue disciplinary action against those who are convicted of certain types of crimes. Offenses that could lead to the suspension or revocation of a professional license include:
Illinois Medical Licensing and Authorization to Administer COVID-19 Vaccines
For more than a year, the COVID-19 pandemic has caused interruptions to many people’s daily lives and activities. Fortunately, an end to this situation is in sight as vaccines are administered to people throughout the United States. To ensure that as many people can be vaccinated as quickly as possible, officials are taking an “all hands on deck” approach, and multiple different types of medical professionals have been authorized to administer these vaccines. To avoid any issues that could affect a person’s medical license, it is important to understand what steps should be followed to obtain authorization to administer vaccines, and medical professionals will want to make sure they are following the correct procedures at all times.
Who Can Administer COVID-19 Vaccines in Illinois?
Governor J.B. Pritzker has declared a public health emergency in the state of Illinois and issued emergency orders to allow certain types of licensed professionals to administer COVID-19 vaccines. Those who are allowed to administer vaccines include:
Requirements for Doctors and Nurses in Medical Marijuana Certifications
Over the past decade, marijuana has been recognized as a substance that can provide patients with a number of medical benefits. Many states, including Illinois, have authorized the use of medical marijuana for patients with certain types of conditions. However, doctors, nurses, or other medical professionals will need to make sure they are following the correct procedures and meeting all requirements when certifying patients to use medical marijuana. Failure to do so could result in disciplinary action by the Illinois Medical Board, the Illinois Board of Nursing, or another division of the Illinois Department of Financial and Professional Regulation (IDFPR).
Health Care Professional Certifications for Medical Cannabis
Before applying for a medical cannabis registry identification card, patients in Illinois will need to receive a certification from a medical professional stating that they have a qualifying debilitating condition. Health care professionals that can provide this certification include medical doctors, doctors of osteopathic medicine, advanced practice nurses, physician assistants, and advance practice registered nurses with full practice authority.
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.
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