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Reasons You Could Lose Your Hospital Privileges That Have Nothing to Do With Patient Care
By their very nature, most physicians—including Medical Doctors (M.D.s) and Doctors of Osteopathic Medicine (D.O.s)—tend to have an independent decision-making spirit. While they are also generally very intelligent and dedicated to their patients, the responsibilities that come with gaining admitting and practicing privileges at a particular hospital can sometimes seem to conflict with a doctor’s sense of independence.
In addition to standards of care, hospital privileges also involve collegial, social, and legal elements that are more complicated than just taking care of patients. A physician who does not live up to all of a hospital’s expectations could quickly find that he or she is in danger of losing membership on the hospital’s medical staff.
Avoid These Types of Behaviors
It is understandable that concerns over the level of care that a physician provides could lead to the possible suspension or termination of the doctor’s hospital privileges. Such concerns could pertain to the doctor’s bedside manner, the failure to seek approval before trying unorthodox treatments, or not reaching out to specialists or consultants for questions outside of the physician’s area of specialty. Repeated incidents could become problematic and lead to the hospital suspending your privileges.
Billing Practices That Could Lead to Losing Your Medicare Enrollment
According to the Centers for Medicare & Medicaid Services (CMS), there are currently more than 60 million Americans who are enrolled as Medicare beneficiaries. This number includes individuals enrolled in “original” Medicare as well as in Medicare Advantage plans with private insurers. In order to be able to serve this large portion of the population, a medical provider must enroll as a Medicare provider and keep that enrollment in good standing. This means the provider must meet all of the requirements set forth by CMS and avoid behaviors that could lead to a revocation of the provider’s Medicare status.
Revocation of Medicare Enrollment
Under §424.535 of the Code of Federal Regulations, there are many different reasons for which a provider could have his or her Medicare enrollment status revoked. They include noncompliance with enrollment requirements, causing harm to patients, being convicted of certain felonies, improper medication prescribing practices, and failing to comply with CMS reporting requirements, among many others.
What to Do If Your Practice Is Under Investigation by the DEA
Have you recently learned that your medical practice or pharmacy is being audited or investigated by the U.S. Drug Enforcement Agency (DEA)? You might have discovered this information by chance or have been informed directly by a DEA agent. Either way, a DEA investigation can be frightening, especially if your livelihood depends on keeping your DEA registration and your professional license. The good news is that our firm is equipped to help healthcare professionals of all types in all types of DEA-related matters.
DEA Tasked With Helping to Manage the Opioid Crisis
Over the last few years, the misuse and abuse of opioid drugs have become major problems throughout the country. In fact, the situation is serious enough that the acting U.S. Secretary of Health and Human Services declared a public health emergency in 2017, and health officials began using the word “epidemic” to describe the widespread nature of the crisis. At the time, the Centers for Disease Control and Prevention estimated that 91 per day were dying from opioid overdoses.
Can the COVID-19 Pandemic Affect an Illinois Nursing Home License?
Because of their important role in providing for the care and health of their patients, Illinois nursing homes are subject to oversight from both the Illinois Department of Public Health (IDPH) and the federal Centers for Medicare and Medicaid Services (CMS) to ensure they are in compliance with regulations. With the additional risks that the COVID-19 pandemic poses for nursing home residents, additional guidelines have been put in place to promote their safety. Now more than ever, it is important for nursing homes to take the necessary measures to avoid violations that could impact their licensure.
Guidelines for Illinois Nursing Homes During COVID-19
Based on guidance from the Centers for Disease Control, CMS has issued guidelines for the safe operation of nursing homes and other long-term care facilities throughout the United States. For example, nursing homes must:
Can a Psychologist Be Sued For Malpractice in Illinois?
Psychologists provide an important service for their patients, who rely on their expertise for therapy and treatment of a wide range of mental and behavioral health issues. Psychologists who breach their patients’ trust may face serious consequences, including the loss of their license. In some cases, they may even face medical malpractice lawsuits.
What Is Medical Malpractice?
Medical malpractice occurs when a healthcare professional breaches his or her duty of care to a patient, resulting in the patient’s injury or harm. For physical healthcare providers, some of the most common forms of malpractice are surgical errors, improper medication or prescriptions, misdiagnosis, and misinterpretation of test results or patient history.
While psychologists may not have a medical degree, they do provide a form of healthcare, and prescribing psychologists are licensed to prescribe medical treatment. Therefore, they may face medical malpractice claims related to improper prescriptions, misdiagnoses, or failure to diagnose a mental health condition. According to the American Psychological Association (APA), some psychologists also face claims of malpractice due to emotional abuse or sexual misconduct with their clients.
How Has COVID-19 Affected Medical Licenses in Illinois?
The global pandemic COVID-19 has hit the U.S. especially hard, with over 199,000 confirmed cases in Illinois alone. From the beginning, this virus has led to overfilled hospital beds and overworked medical professionals. With no vaccination in sight and a high demand for doctors, nurses, and other medical professionals, the U.S. has been forced to reevaluate their licensing procedures and state-by-state restrictions. It is common for states to adopt emergency licensing processes in response to natural disasters and their aftermath. Many states have followed this trend by enacting emergency-response licensure laws to allow volunteers from other states to practice their profession without being required to seek out licensure in that specific state.
Uniform Emergency Volunteer Health Practitioner Act
The Uniform Emergency Volunteer Health Practitioner Act (UEVHPA) is legislation that was initially developed in 2006 and is being modeled by many states during the COVID-19 pandemic. This legislation allows any participating state, Illinois included, to recognize out-of-state medical licenses during a declared state emergency. All practitioners who wish to participate in this reciprocal-licensing program must register to do so.
Can I Work as a Nurse in Illinois If I am Licensed in Another State?
It is fairly recognized that nursing school is not an easy path to take. While slightly less rigorous than medical school, those who wish to be Illinois nurses are still required to take intense courses aimed at preparing them for in-field work and the difficult exam, known as the NCLEX-RN, to become a registered nurse. This exam is a national, standardized test to ensure that future nurses are fully capable of taking care of patients and performing other medical duties.
Since many nursing students take their NCLEX exam coming out of college, they will typically receive nursing licensure in the state where they went to school. However, it is unlikely that these medical professionals will never move out of state. For those moving to Illinois, there is a particular process that they must follow to become an Illinois certified nurse.
Out-of-State Licensure
If a nurse moves from one state to another and still intends on working in this field, they will need to receive “licensure by endorsement” in the new state that they are moving to. In other words, out of state nurses must receive license verification and endorsement from the previous state(s) that they worked in. This includes the current state, the original state (if different), and any other state that the nurse has practiced over the past five years. Illinois requires nurses to provide their NCLEX results, either from the state of original licensure or the testing company. These endorsement candidates can be issued a temporary license to begin work while the paperwork is being processed.
What Are the Requirements to Become a Licensed Dentist in Illinois?
There are many types of professions that are regulated in Illinois, such as cosmetology, psychology, financial services, and even architecture. One regulated profession that does not come as much of a surprise is dentistry. The Illinois Department of Financial and Professional Regulation (IDFPR) oversees the licensing, continuing education, practice, and discipline of dentists and related professions in the state. Becoming a dentist takes years of hard work and study, but getting your dental license requires you to know all of the requirements before you apply for your Illinois dental license.
General Dentistry Licenses
Like many other health-related professions in Illinois and throughout the country, you must have a license to practice dentistry in Illinois. To obtain a license to practice general dentistry, you must:
- Be at least 21 years old
- Be of “good moral character”
How Can Physician Burnout Effect Professional Licensure in Illinois?
At some point, we have all felt exhausted, cynical, or unhappy with our jobs. This is called burnout and it can have negative effects on job performance and personal happiness. Physician burnout has been one of the topics of concern among the medical community for a few years now. According to the American Medical Association (AMA), more than 40 percent of all physicians in the United States report experiencing signs of burnout. Physician burnout has been linked to higher rates of medical errors, lower quality of patient care, and a higher rate of physician drug and alcohol abuse and/or addiction. Physician burnout and its associated outcomes could have serious implications for your Illinois medical license.
Signs of Burnout
Burnout is a long-term response to work-related stress that is characterized by emotional exhaustion, depersonalization, and diminished feelings of personal accomplishment. Burnout is not unique to medical professions, but physicians tend to be more prone than others. Other symptoms of burnout can include:
What You Should Know About PBM Pharmacy Audits in Illinois
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.
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