By Nora Ciancio
Most of my practice focuses on representing practitioners in licensing matters. What does this mean? When Board investigators start asking questions or the Board wants to see you for a hearing, I step in to defend. If a violation of practice has occurred in the case, the Board will issue disciplinary action against the provider’s license via a public order. The finalization of the order signals the end of the Board case.
Instinctively, at this juncture, most practitioners want to relish in momentary relief after months of anguish. Unfortunately, however, a Board order can bleed into multiple other areas of your profession, including credentialing with third party payors, the National Practitioner Data Bank, facility privileges, national accreditation and certification bodies, and licensure in other states.
So, what is a provider supposed to do to address and protect themselves from the resulting fallout?
1. Update your contact information. I cannot tell you how many times we have had clients miss appeal deadlines or a chance to explain themselves before adverse action is taken simply because the notice has been sent to an old address. As the provider, it is your responsibility to make sure all contact information is up to date.
2. Verify whether you have any requirements to self-report a Board investigation or disciplinary action. Check your contracts, provider agreements, bylaws, and the guidelines in other states where you are licensed to see if you are obligated to notify these entities of the Board case. If mandated, failure to report often leads to automatic and predetermined adverse action. If you are unsure how to interpret the language in these documents, ask your attorney to review.
3. Pay attention to deadlines and dates given to you in any notices. Check your mail and email regularly. Contact an attorney as quickly as possible when you receive inquiries or notices from third party payors, CMS, accreditation organizations, or other state licensing bodies. Missing deadlines can prohibit you from appealing adverse actions.
4. Have a written explanation ready to use. It is commonplace for me to draft statements for clients to use in subsequent inquiries explaining the provider’s rationale, the Board’s findings, and the disciplinary action. These explanations can be tailored to specific bodies, or they may be general statements that the provider repurposes for multiple inquiries.
5. Check with your malpractice insurance for coverage for attorney’s fees. If your malpractice carrier covered all or some of the attorney’s fees associated with the Board case, they might agree to cover any action arising as a direct result.
In today’s complaint-heavy society, it is not unusual for health care professionals to be the subject of a Board case. Appropriately handling what comes after can mean the difference between overcoming a disciplinary action and not having the opportunity to continue without your practice being severely affected.
Nora Ciancio joined Goodman Allen Donnelly in 2017 and has focused on representing health care professionals in licensing and discipline matters before their professional boards. She also offers representation in Medicaid and Medicare provider appeals, credentialing and third-party payor audits, as well as advises practices on regulatory and compliance issues. goodmanallen.com