For a doctor or other practicing health care professional, a complaint that leads to an investigation by the State Board of Medicine can be devastating to your professional career, as well as your personal and financial well being. A doctor may find himself or herself simultaneously defending against a disciplinary board investigation which threatens his/her license, an action to take away his/her hospital privileges or DEA license to prescribe drugs,, an administrative action to recoup Medicare/Medicaid payments, federal and state criminal charges. When confronted with a possible lawsuit or disciplinary action, it is essential to seek the advice and counsel of an experienced health care lawyer who has extensive experience defending physicians.
Complaints overseen by state medical boards are primarily concerned with issues relating to unprofessional conduct, quality of care, or criminal behavior of a personal or professional nature. These types of allegations can risk putting an end to a medical practice, and require a strong and highly skilled health care defense lawyer.
Complaints that may lead to a suspension or revocation of a medical license may include:
- Arrests or convictions for illegal use of controlled substances or driving under the influence of alcohol
- Other acts or criminal violations that may affect “fitness to practice” or “moral turpitude”
- Improper billing practices under Medicare or Medicaid, such as upcoding of claims for reimbursement or making claims for services that were never rendered or were not medically necessary,
- Poor documentation or record keeping, such as failing to keep accurate, up-to-date, patient medical records and sufficient documentation to fully support all claims for reimbursement.
- Insurance fraud or other financial misconduct, such asmaking inaccurate or false claims to insurance carriers for reimbursement, or charging different fees for private payers versus those with insurance.
- Pain management and prescription violations – Dispensing or prescribing medications outside of accepted medical treatment principles, willful dispensing of a controlled substance without proper labeling, or prescribing medications to a drug dependent person.
- Sexual misconduct – improper sexual contact or relations with patients
- Patient abuse, harassment, or neglect – Any action or failure to act that causes harm to a patient can lead to one of these charges.
- Practicing without a license – Licenses must always be kept current and valid, and it is never acceptable to falsify or misrepresent the status of a license or professional certificate.
- Failure to notify a state medical board of an arrest or conviction in another state, or an adverse disciplinary action taken by a state medical board in another state
Consequences
Investigations into any of the preceding complaints or other charges can have serious implications for your medical practice. A formal hearing or criminal proceeding may result in fines and loss of medical staff privileges. You also run the risk of having your medical license restricted, suspended, or even revoked.
In some cases, a state medical board may impose remedial, non-disciplinary orders on physicians. Unfortunately, this often causes insurance companies to cancel a physician’s contract, even if that was not the intention of the medical board. Furthermore, investigations and regulatory actions can seriously and permanently damage a physician’s reputation. It is not uncommon for medical practices or physicians dealing with these consequences to see their business decline by 50% or more.
It is important to remember that the state medical board is not a physician’s ally. Their goal is to investigate, prosecute, and convict. Recent public and political outcry for greater transparency of regulatory agencies has led to increased scrutiny of, and tougher enforcement against, medical practitioners who violate statutes and codes of conduct.
Pennsylvania Health Care Lawyers at Michelman & Bricker Provide Experienced Defense for Health Care Professionals
Early preparation is the key to a successful defense when physicians are faced with a possible investigation. At times, a well thought out response to a medical board inquiry can stop further proceedings that can threaten a successful practice. The Philadelphia health care lawyers at Michelman & Bricker, P.C. have extensive experience representing physicians and other health care professionals in matters regarding professional licensing, disciplinary actions, and license suspensions and revocations. To discuss your case with a reputable Philadelphia health care lawyer today, call 215-557-9440 to schedule your consultation or contact us online.
Our offices are located in Philadelphia, Pennsylvania, Cherry Hill, New Jersey and Longmeadow, Massachusetts allowing us to conveniently serve clients in Harrisburg, Philadelphia, Cherry Hill and throughout all areas of Camden County.