Healthcare practitioners are subject to a myriad of regulations, including privacy, billing, licensing, credentialing, and ethical regulations, etc. Disciplinary issues can include violation or breach of either legal and ethical guidelines. Some disciplinary actions are taken for violations of federal law, such as violation of Centers for Medicare and Medicaid Services (CMS) rules.
Disciplinary Actions Against Healthcare Practitioners
With so many federal and state laws and regulations governing health care providers and businesses, it is no surprise that disciplinary actions often arise. Healthcare practitioners are subject to a myriad of regulations, including privacy, billing, licensing, credentialing, and ethical regulations, etc.
What are some of the most common disciplinary issues and sanctions?
Disciplinary issues can include violation or breach of either legal and ethical guidelines. Some disciplinary actions are taken for violations of federal law, such as violation of Centers for Medicare and Medicaid Services (CMS) rules. For instance, if CMS discovers that documentation does not support the prescribed treatment or if there are missing or incomplete certifications, it can conduct disciplinary review and implement sanctions. HIPAA violations are another common area for disciplinary action. HIPAA requires employers to sanction their employees who violate the procedures, which are considered in addition to typical employee disciplinary measures.
Other disciplinary actions are implemented from state licensing boards. These violations often include failure to renew a license, incomplete continuing education credits, drug testing violations, and issues of dishonesty or fraud. Healthcare professionals may face sanctions that include:
How does the federal government keep track of disciplinary matters?
The federal government records and keeps track of practitioner disciplinary matters through the National Practitioner Data Base (NPDB). The NPDB is a federal regulatory body that collects information about adverse behaviors (including disciplinary actions) related to health care practitioners, providers, and suppliers. A report to the NPDB can result in severe negative consequences for a healthcare practitioner.
How do states regulate disciplinary behaviors for health care providers and businesses?
Individual states also record and publish disciplinary actions against healthcare practitioners licensed in the state. The Colorado Division of Professions and Occupations, for example, created the Healthcare Professions Profile Program (HPPP). HPPP is “an online database to help consumers find a healthcare provider that meets their needs and expectations.” The goal of HPPP is to aid health care consumers when making choices about their health. Similar to the NPDB, the HPPP records information about disciplinary actions, restrictions and suspensions, criminal convictions, business conflicts of interest, and malpractice insurance settlements.
Disciplinary actions are not limited to state licensing boards. For example, physician board certification organizations will almost always automatically rescind board certification privileges of a physician who has been convicted in a state licensing disciplinary matter. Although obtaining a certification with these organizations is supposedly “voluntary,” most hospitals and insurance companies require board certification as a prerequisite for enrollment and credentialing. Physicians will have to file an appeal for reconsideration plus a fee to negotiate their board certification status. Loss of board certification, even if there has just been a limited probationary penalty from the state licensing board, can snowball into loss of privileges at hospitals and with many insurance companies. Therefore, it is very important to immediately address disciplinary issues at the licensing and certification boards.
What to do if there is a disciplinary action against you?
With respect to the legal issues and fees for state licensing board matters, your malpractice insurance generally recommends insurance lawyers and covers the costs. The problems begin when physicians neglect the board certification, hospital credentialing and insurance enrollment requirements. Many certification boards’ bylaws require self-reporting of any disciplinary investigation. Hospital privileges rules and insurance enrollment may also impose such self-reporting. As such, it is important to find and hire a healthcare attorney who can assist you with these issues at the same time you engage the licensing board attorney or before passing the deadlines for reporting. Because many malpractice insurance attorneys are not “healthcare regulatory attorneys "they may not be versed in managing these healthcare regulatory complications that arise simultaneously with state licensing board issues.
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Perla Business Administrative Process Management
Healthcare imposes a lot of requirements on a healthcare business. And, non-compliance with the rules and regulations can lead to disciplinary issues. For example, failure to timely complete CMEs may cause a state licensing board to impose sanctions on a practitioner’s license. Or, failure to have updated HIPAA policies and procedures, when investigated by the Office of Civil Rights, can lead to state disciplinary issues. Maintaining updated CME status or HIPAA policies is challenging because physicians and their staff must manage very complex healthcare businesses which includes clinical and administrative business management issues. The clinical management is so complex at times, that the administrative tasks and management would suffer.
Perla provides a web-based tool for healthcare practitioners to automate the management and standardize the organization of business documents and devices of a practice. With the Perla document and device management tools, you can streamline organization of your documents, set deadlines and notifications for review of documents, calibration of devices or termination or renegotiation of undesirable contracts. As practices lose up to 30% of their revenues to inefficient business processes, Perla’s simple administrative organizational tool, not only can enhance compliance and efficiency, but also capture revenue losses associated with administrative inefficiency. Go to www.goperla.com/medical-business-suite-application to sign up for your medical business suite.
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