The problem with the sexual contact with a co-employee is that the situation can often lead to the dismissal from the health care facility or hospital. When that happens the dismissal will be reported to the Department of Health and you might get investigated by OPMC. Also, you will have to explain why you were dismissed when you renew your medical license. If you lie about the situation on your renewal form that lying, if discovered, will be misconduct in and of itself.
Check your health insurance policy as it is quite possible that this therapy will be paid for. But, please read your policy carefully as there may be some clauses that limit coverage for this type of “illness”. I know of a situation where the health insurer paid for the first 7 weeks of therapy until the physician was allowed to spend a week-end at home. The insurer refused to pay for the several weeks of additional rehabilitation in the facility on the ground that the therapy was not necessary because the physician had been permitted to go home unsupervised for that week-end.
One thing a medical professional can do to make things easier in the substance abuse arena is to join a program with the Committee for Physician Health, (CPH). A program with CPH will have you going to meetings on probably a weekly basis and you agree to random drug testing on a routine basis. Often there will be a contract that will last for 5 years for the meetings and testing. OPMC looks very favourably on professionals who have a problem with addiction when they are in this CPH program. It is felt that you are being tested on a frequent basis and should you go back to your addiction you will quickly be discovered and in this way the public is protected.
When an HMO charges a physician with overcharging for services, the situation can become dangerous for the doctor. At the worst, the HMO can report the doctor to the Department of Health with the charge of fraudulent billing. If that happens, not only might the doctor have to repay a good deal of money to the HMO, but there will be an OPMC investigation to deal with. The doctor needs to consider negotiating a settlement with the HMO to put the matter to rest.
Settlements of medical malpractice cases are reported by insurance companies to the Department of Health. Of course, the larger the settlement the more attention the matter will bring. However, while OPMC can investigate any settlement, it usually begins to look at a physician more carefully if there are several settlements in a relatively short period of time. This can be proof that the physician has a problem of some type, be it incompetence, a substance abuse issue or some other systemic difficulty that might put patients in danger. Also, multiple settlements will be reported on OPMC’s website for the public to see. So, be careful when you give your consent to settle a malpractice case as a payment may bring you up on OPMC’s radar screen.
As a medical provider in private practice if you are going to bill an HMO I recommend that you and your staff retain a billing firm to give instruction as to how to properly bill your services. Not only will this information keep you out of a billing issue with the HMO, but you will also learn how to legally maximize your billing to capture the highest amount permitted. You want to avoid a claim of over billing because not only could that claim cost you a very large amount in repayments, but you also might be in an allegation of fraud situation with the Department of Health or the Department of Education.
Yes, the application fee to restore a suspended New York Physician’s license is $750.00 payable to the Department of Education.
If you have lost your medical license in New York state, you truly have an uphill climb to have the license restored. You really have to start the restoration process the day your license is revoked. You can apply for restoration after three years from the date of revocation but you have to really be dedicated to do all of the things necessary to give yourself a fighting chance to have the license restored. Please see my article on this subject.
New York lawyer Paul E. Walker, is a Manhattan based expert in defending medical professionals. If you are looking for an attorney to represent you with the OPMC or OPD, the Office of Professional Medical Conduct (“OPMC”) of the New York State Department of Health may conduct investigations and issue disciplinary sanctions after trial. OPMC sanctions can have serious consequences … Continue reading →
The Office of Professional Medical Conduct (“OPMC”) of the New York State Department of Health may conduct investigations and issue disciplinary sanctions after trial. OPMC sanctions can have serious consequences for physicians and physician assistants including public reprimand, censure, loss of license or probation. If you are looking for an attorney to represent you with the OPMC or OPD, attorney … Continue reading →
If your hospital charges you with misconduct you must take the situation very seriously as the end result may cause damage to the rest of your career. Continue reading →
If you read your contract with an HMO it probably says that you have waived your right to a trial on the issue of billing audits and have instead agreed to submit the dispute to binding arbitration.
It is not unusual to see an HMO calculate that if you billed, for instance, $200,000 over the last 6 years, that you over billed on the entire amount and therefore you owe the HMO $50,000, that is, 25% of the amount. Continue reading →
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