Frequently Asked Questions (FAQs) by Health Care Professionals:
Billing Fraud (3)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
Defending License Revocation (6)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
How does the settlement of a malpractice case impact on an OPMC investigation?
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.
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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.
Inappropriate Sexual Contact (5)
What are the possible problems that can arise from a sexual event with a patient?
At least three areas of difficulty can be effected by a sexual event and they are a criminal prosecution, a possible loss of license and a civil law suit for assault. If you plead guilty to a misdemeanor or a felony you will probably lose your medical license very soon thereafter. There really is no defense to the charge of misconduct as you have admitted guilt to a “crime” and that by itself is grounds for you to have your license revoked. If a civil suit for assault follows, the legal fees will not be covered by an insurance company so you will have to pay your own lawyer. Also, the case will be difficult to defend as the criminal conviction against you will be allowed into evidence at the civil trial.
Remember, while a guilty plea might keep you out of jail, it can have a ruinous effect on your medical license.
How will I know if a patient is going to report me for having a sexual event?
Often what happens is that the health care provider receives a phone call from the patient saying that the sexual event was not appreciated. Many times that phone call is being made from the District Attorney’s office and is being tape recorded. If you acknowledge that this event did in fact take place, you will no doubt be indicted for assault. Because of your admission on the phone, you might very well have to plead guilty just to stay out of jail. Then OPMC will be notified and your medical license will probably be revoked. Then, you can be sued civilly for money damages and you will not have much in the way of a defense by that time. (Also, note that the process can be started by a visit to your office by the patient while the patient is wearing a recording device.)
As a physician, is it permissible to have sex with the relatives of my patients?
This most often comes up with the mothers of pediatric patients and believe me the answer to the question is a resounding “no”. OPMC will charge you with immoral conduct if you do this and they will investigate to see if you have done it once or if you are doing this on a routine basis over time. Obviously, the more you have done it the worse things might get regarding your license. Also, if there is sexual conduct in the presence of the pediatric patients that makes matters even worse. You might get away with this if there was one person and the sexual conduct was out of the office with no children in the area.
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
Insurance Fraud (3)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
License Restoration (5)
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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 (9)
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
As a physician, is it permissible to have sex with the relatives of my patients?
This most often comes up with the mothers of pediatric patients and believe me the answer to the question is a resounding “no”. OPMC will charge you with immoral conduct if you do this and they will investigate to see if you have done it once or if you are doing this on a routine basis over time. Obviously, the more you have done it the worse things might get regarding your license. Also, if there is sexual conduct in the presence of the pediatric patients that makes matters even worse. You might get away with this if there was one person and the sexual conduct was out of the office with no children in the area.
How will I know if a patient is going to report me for having a sexual event?
Often what happens is that the health care provider receives a phone call from the patient saying that the sexual event was not appreciated. Many times that phone call is being made from the District Attorney’s office and is being tape recorded. If you acknowledge that this event did in fact take place, you will no doubt be indicted for assault. Because of your admission on the phone, you might very well have to plead guilty just to stay out of jail. Then OPMC will be notified and your medical license will probably be revoked. Then, you can be sued civilly for money damages and you will not have much in the way of a defense by that time. (Also, note that the process can be started by a visit to your office by the patient while the patient is wearing a recording device.)
What are the possible problems that can arise from a sexual event with a patient?
At least three areas of difficulty can be effected by a sexual event and they are a criminal prosecution, a possible loss of license and a civil law suit for assault. If you plead guilty to a misdemeanor or a felony you will probably lose your medical license very soon thereafter. There really is no defense to the charge of misconduct as you have admitted guilt to a “crime” and that by itself is grounds for you to have your license revoked. If a civil suit for assault follows, the legal fees will not be covered by an insurance company so you will have to pay your own lawyer. Also, the case will be difficult to defend as the criminal conviction against you will be allowed into evidence at the civil trial.
Remember, while a guilty plea might keep you out of jail, it can have a ruinous effect on your medical license.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
If I plead guilty to drunk driving what are the possible ramifications with OPMC?
If this is your first offense, things will be easier for you. You probably will be sanctioned and receive a fine. The degree of sanction and fine is to some extent dependant on your alcohol level. You also might have to go to substance abuse therapy and you will have to pay for that therapy. Obviously, if this is your second or third offense things get worse. The same is true if your drunk driving caused property damage or personal injury and if you also left the scene of an accident, etc.
What do I do if am facing a drunk driving criminal charge?
You first have to understand that if you plead guilty to a felony or misdemeanor you will have admitted that you are guilty of having committed a “crime”. This conviction will no doubt be forwarded to the OPMC. But in any event, when you renew your medical license there will be a question asking have you been convicted of a crime since your last renewal. You must answer “yes” because a “no” answer will be a lie and that answer in and of itself will be “misconduct”. In view of this, you must try to have your criminal lawyer get a plea to a violation as opposed to a felony or misdemeanor. This is truly important since a violation is not a “crime” and therefore does not need to be reported.
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Nurses (2)
Can a nurse maintain a license in a substance abuse situation?
The answer is a qualified yes. A nurse, like a doctor, must start with rehabilitation therapy and that might convince the Department of Education that the nurse is capable of treating patients without being a danger to those patients. The entire situation has to be handled very carefully with an experienced lawyer.
What can be done to prevent a claim of overbilling by an HMO?
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.
Physcians (8)
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
If I have to go to Rehab, who will pay for the therapy?
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.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
How does the settlement of a malpractice case impact on an OPMC investigation?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
Restoration of a suspended physician’s license in New York
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.
Physician Assistants (1)
What can be done to prevent a claim of overbilling by an HMO?
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.
Substance Abuse (9)
What is the effect of a DUI conviction regarding my medical license?
If you plead guilty to a felony or a misdemeanor you will certainly receive a letter from OPMC and the only issue will be what level of punishment will be handed to you. The most usual sanction is a Censure and Reprimand which is then posted on the OPMC website. Also, you will have to reveal the sanction to hospitals, insurance companies and almost any other professional entity that you apply to. This is not only embarrassing but it may cause your application to be rejected. Of course, if you have a string of drunk driving convictions you might lose your license or have to go into intensive therapy with random urine testing for perhaps five years. Do not drink and drive!
What do I do if am facing a drunk driving criminal charge?
You first have to understand that if you plead guilty to a felony or misdemeanor you will have admitted that you are guilty of having committed a “crime”. This conviction will no doubt be forwarded to the OPMC. But in any event, when you renew your medical license there will be a question asking have you been convicted of a crime since your last renewal. You must answer “yes” because a “no” answer will be a lie and that answer in and of itself will be “misconduct”. In view of this, you must try to have your criminal lawyer get a plea to a violation as opposed to a felony or misdemeanor. This is truly important since a violation is not a “crime” and therefore does not need to be reported.
If I plead guilty to drunk driving what are the possible ramifications with OPMC?
If this is your first offense, things will be easier for you. You probably will be sanctioned and receive a fine. The degree of sanction and fine is to some extent dependant on your alcohol level. You also might have to go to substance abuse therapy and you will have to pay for that therapy. Obviously, if this is your second or third offense things get worse. The same is true if your drunk driving caused property damage or personal injury and if you also left the scene of an accident, etc.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
If I have to go to Rehab, who will pay for the therapy?
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.
Can I recover any of my lost income while I am in Rehab?
Take a look at your disability policy, it may replace a great deal of your lost income while you are in Rehab. But you have to understand that not all disability policies are the same. The time to carefully read a disability policy to understand its terms is before you buy it, not when you are sitting in a rehabilitation facility. Talk to your insurance broker about the available coverage to make sure your policy covers as many types of situations as possible.
Can a nurse maintain a license in a substance abuse situation?
The answer is a qualified yes. A nurse, like a doctor, must start with rehabilitation therapy and that might convince the Department of Education that the nurse is capable of treating patients without being a danger to those patients. The entire situation has to be handled very carefully with an experienced lawyer.
Therapists (1)
What can be done to prevent a claim of overbilling by an HMO?
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.
Substance Abuse
What is the effect of a DUI conviction regarding my medical license?
If you plead guilty to a felony or a misdemeanor you will certainly receive a letter from OPMC and the only issue will be what level of punishment will be handed to you. The most usual sanction is a Censure and Reprimand which is then posted on the OPMC website. Also, you will have to reveal the sanction to hospitals, insurance companies and almost any other professional entity that you apply to. This is not only embarrassing but it may cause your application to be rejected. Of course, if you have a string of drunk driving convictions you might lose your license or have to go into intensive therapy with random urine testing for perhaps five years. Do not drink and drive!
What do I do if am facing a drunk driving criminal charge?
You first have to understand that if you plead guilty to a felony or misdemeanor you will have admitted that you are guilty of having committed a “crime”. This conviction will no doubt be forwarded to the OPMC. But in any event, when you renew your medical license there will be a question asking have you been convicted of a crime since your last renewal. You must answer “yes” because a “no” answer will be a lie and that answer in and of itself will be “misconduct”. In view of this, you must try to have your criminal lawyer get a plea to a violation as opposed to a felony or misdemeanor. This is truly important since a violation is not a “crime” and therefore does not need to be reported.
If I plead guilty to drunk driving what are the possible ramifications with OPMC?
If this is your first offense, things will be easier for you. You probably will be sanctioned and receive a fine. The degree of sanction and fine is to some extent dependant on your alcohol level. You also might have to go to substance abuse therapy and you will have to pay for that therapy. Obviously, if this is your second or third offense things get worse. The same is true if your drunk driving caused property damage or personal injury and if you also left the scene of an accident, etc.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
If I have to go to Rehab, who will pay for the therapy?
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.
Can I recover any of my lost income while I am in Rehab?
Take a look at your disability policy, it may replace a great deal of your lost income while you are in Rehab. But you have to understand that not all disability policies are the same. The time to carefully read a disability policy to understand its terms is before you buy it, not when you are sitting in a rehabilitation facility. Talk to your insurance broker about the available coverage to make sure your policy covers as many types of situations as possible.
Can a nurse maintain a license in a substance abuse situation?
The answer is a qualified yes. A nurse, like a doctor, must start with rehabilitation therapy and that might convince the Department of Education that the nurse is capable of treating patients without being a danger to those patients. The entire situation has to be handled very carefully with an experienced lawyer.
Billing Fraud
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
Billing Fraud (3)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
Defending License Revocation (6)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
How does the settlement of a malpractice case impact on an OPMC investigation?
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.
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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.
Inappropriate Sexual Contact (5)
What are the possible problems that can arise from a sexual event with a patient?
At least three areas of difficulty can be effected by a sexual event and they are a criminal prosecution, a possible loss of license and a civil law suit for assault. If you plead guilty to a misdemeanor or a felony you will probably lose your medical license very soon thereafter. There really is no defense to the charge of misconduct as you have admitted guilt to a “crime” and that by itself is grounds for you to have your license revoked. If a civil suit for assault follows, the legal fees will not be covered by an insurance company so you will have to pay your own lawyer. Also, the case will be difficult to defend as the criminal conviction against you will be allowed into evidence at the civil trial.
Remember, while a guilty plea might keep you out of jail, it can have a ruinous effect on your medical license.
How will I know if a patient is going to report me for having a sexual event?
Often what happens is that the health care provider receives a phone call from the patient saying that the sexual event was not appreciated. Many times that phone call is being made from the District Attorney’s office and is being tape recorded. If you acknowledge that this event did in fact take place, you will no doubt be indicted for assault. Because of your admission on the phone, you might very well have to plead guilty just to stay out of jail. Then OPMC will be notified and your medical license will probably be revoked. Then, you can be sued civilly for money damages and you will not have much in the way of a defense by that time. (Also, note that the process can be started by a visit to your office by the patient while the patient is wearing a recording device.)
As a physician, is it permissible to have sex with the relatives of my patients?
This most often comes up with the mothers of pediatric patients and believe me the answer to the question is a resounding “no”. OPMC will charge you with immoral conduct if you do this and they will investigate to see if you have done it once or if you are doing this on a routine basis over time. Obviously, the more you have done it the worse things might get regarding your license. Also, if there is sexual conduct in the presence of the pediatric patients that makes matters even worse. You might get away with this if there was one person and the sexual conduct was out of the office with no children in the area.
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
Insurance Fraud (3)
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
License Restoration (5)
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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 (9)
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
As a physician, is it permissible to have sex with the relatives of my patients?
This most often comes up with the mothers of pediatric patients and believe me the answer to the question is a resounding “no”. OPMC will charge you with immoral conduct if you do this and they will investigate to see if you have done it once or if you are doing this on a routine basis over time. Obviously, the more you have done it the worse things might get regarding your license. Also, if there is sexual conduct in the presence of the pediatric patients that makes matters even worse. You might get away with this if there was one person and the sexual conduct was out of the office with no children in the area.
How will I know if a patient is going to report me for having a sexual event?
Often what happens is that the health care provider receives a phone call from the patient saying that the sexual event was not appreciated. Many times that phone call is being made from the District Attorney’s office and is being tape recorded. If you acknowledge that this event did in fact take place, you will no doubt be indicted for assault. Because of your admission on the phone, you might very well have to plead guilty just to stay out of jail. Then OPMC will be notified and your medical license will probably be revoked. Then, you can be sued civilly for money damages and you will not have much in the way of a defense by that time. (Also, note that the process can be started by a visit to your office by the patient while the patient is wearing a recording device.)
What are the possible problems that can arise from a sexual event with a patient?
At least three areas of difficulty can be effected by a sexual event and they are a criminal prosecution, a possible loss of license and a civil law suit for assault. If you plead guilty to a misdemeanor or a felony you will probably lose your medical license very soon thereafter. There really is no defense to the charge of misconduct as you have admitted guilt to a “crime” and that by itself is grounds for you to have your license revoked. If a civil suit for assault follows, the legal fees will not be covered by an insurance company so you will have to pay your own lawyer. Also, the case will be difficult to defend as the criminal conviction against you will be allowed into evidence at the civil trial.
Remember, while a guilty plea might keep you out of jail, it can have a ruinous effect on your medical license.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
If I plead guilty to drunk driving what are the possible ramifications with OPMC?
If this is your first offense, things will be easier for you. You probably will be sanctioned and receive a fine. The degree of sanction and fine is to some extent dependant on your alcohol level. You also might have to go to substance abuse therapy and you will have to pay for that therapy. Obviously, if this is your second or third offense things get worse. The same is true if your drunk driving caused property damage or personal injury and if you also left the scene of an accident, etc.
What do I do if am facing a drunk driving criminal charge?
You first have to understand that if you plead guilty to a felony or misdemeanor you will have admitted that you are guilty of having committed a “crime”. This conviction will no doubt be forwarded to the OPMC. But in any event, when you renew your medical license there will be a question asking have you been convicted of a crime since your last renewal. You must answer “yes” because a “no” answer will be a lie and that answer in and of itself will be “misconduct”. In view of this, you must try to have your criminal lawyer get a plea to a violation as opposed to a felony or misdemeanor. This is truly important since a violation is not a “crime” and therefore does not need to be reported.
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Nurses (2)
Can a nurse maintain a license in a substance abuse situation?
The answer is a qualified yes. A nurse, like a doctor, must start with rehabilitation therapy and that might convince the Department of Education that the nurse is capable of treating patients without being a danger to those patients. The entire situation has to be handled very carefully with an experienced lawyer.
What can be done to prevent a claim of overbilling by an HMO?
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.
Physcians (8)
If I have sexual contact with a fellow employee will OPMC take action against me?
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.
If I have to go to Rehab, who will pay for the therapy?
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.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
How does the settlement of a malpractice case impact on an OPMC investigation?
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.
What can be done to prevent a claim of overbilling by an HMO?
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.
Restoration of a suspended physician’s license in New York
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.
Physician Assistants (1)
What can be done to prevent a claim of overbilling by an HMO?
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.
Substance Abuse (9)
What is the effect of a DUI conviction regarding my medical license?
If you plead guilty to a felony or a misdemeanor you will certainly receive a letter from OPMC and the only issue will be what level of punishment will be handed to you. The most usual sanction is a Censure and Reprimand which is then posted on the OPMC website. Also, you will have to reveal the sanction to hospitals, insurance companies and almost any other professional entity that you apply to. This is not only embarrassing but it may cause your application to be rejected. Of course, if you have a string of drunk driving convictions you might lose your license or have to go into intensive therapy with random urine testing for perhaps five years. Do not drink and drive!
What do I do if am facing a drunk driving criminal charge?
You first have to understand that if you plead guilty to a felony or misdemeanor you will have admitted that you are guilty of having committed a “crime”. This conviction will no doubt be forwarded to the OPMC. But in any event, when you renew your medical license there will be a question asking have you been convicted of a crime since your last renewal. You must answer “yes” because a “no” answer will be a lie and that answer in and of itself will be “misconduct”. In view of this, you must try to have your criminal lawyer get a plea to a violation as opposed to a felony or misdemeanor. This is truly important since a violation is not a “crime” and therefore does not need to be reported.
If I plead guilty to drunk driving what are the possible ramifications with OPMC?
If this is your first offense, things will be easier for you. You probably will be sanctioned and receive a fine. The degree of sanction and fine is to some extent dependant on your alcohol level. You also might have to go to substance abuse therapy and you will have to pay for that therapy. Obviously, if this is your second or third offense things get worse. The same is true if your drunk driving caused property damage or personal injury and if you also left the scene of an accident, etc.
If I am charged with substance abuse, be it alcohol or drugs, what can I do to help me keep my license?
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.
If I have to go to Rehab, who will pay for the therapy?
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.
Can I recover any of my lost income while I am in Rehab?
Take a look at your disability policy, it may replace a great deal of your lost income while you are in Rehab. But you have to understand that not all disability policies are the same. The time to carefully read a disability policy to understand its terms is before you buy it, not when you are sitting in a rehabilitation facility. Talk to your insurance broker about the available coverage to make sure your policy covers as many types of situations as possible.
Can a nurse maintain a license in a substance abuse situation?
The answer is a qualified yes. A nurse, like a doctor, must start with rehabilitation therapy and that might convince the Department of Education that the nurse is capable of treating patients without being a danger to those patients. The entire situation has to be handled very carefully with an experienced lawyer.
Therapists (1)
What can be done to prevent a claim of overbilling by an HMO?
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.
Defending License Revocation
Can you negotiate a settlement with an HMO in the setting of a claim of improper billing?
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.
How does the settlement of a malpractice case impact on an OPMC investigation?
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.
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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.
License Restoration
Can sanction Orders on the OPMC website be expunged?
If you were sanctioned by OPMC perhaps 15 years ago you might want to ask OPMC to remove the public sanction from its website. The regulations say that OPMC must keep the sanction Order public for 10 years. So, it would seem that OPMC has the discretion to take an old sanction Order off the website. However, in my experience OPMC will simply not remove any Order. I suppose you could go to court to say that OPMC is acting in an arbitrary fashion when it refuses to remove a very old sanction, but that would be expensive and I am not at all sure a court would substitute its judgment for that of OPMC.
Can records at the OPD be expunged?
Requests can be made but for the most part OPD will not remove a sanction unless there is truly a compelling reason. You should try to have it removed, do not be surprised if the answer is no.
Restoration of a suspended physician’s license in New York
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.
