Todd Collis – Page 2 – Ohio Medical Board Defense Counsel Blog

What is a Medicaid Exclusion and Is There a Way to Appeal These Decisions?

The Department of Health and Human Services has the authority to exclude certain individuals from participating in Medicare, Medicaid, and all Federal health care programs as defined by 1128B(f) of the Social Security Act.

Exclusion from participation can materially affect a professional’s scope of practice because exclusion prohibits the professional from submitting or causing claims to be submitted to any Federal health care program (such as Medicare, Medicaid, VA, TRICARE, the Military Direct Care System, etc.) for any items or services the professional provides and prevents the professional for working in any capacity for an organization that accepts Federal funding. (However, exclusion does not prevent the professional or their family members from receiving benefits to which they are entitled under a Federal program.)

There are two types of exclusion: Mandatory Exclusion is required for certain offenses (42 USC §1320a-7(a)) and Permissive Exclusion is discretionary and may be imposed for certain other offenses (42 USC §1320a-7(b)).

Generally, mandatory exclusion is required for a (i) conviction of health care program-related crimes, (ii) conviction related to patient abuse, (iii) felony conviction related to health care fraud, and (iv) felony conviction related to controlled substances.

Generally, permissive exclusion may be imposed for a number of different offenses including but not limited to (i) a misdemeanor conviction related to controlled substances, (ii) a health care license revocation or suspension, and (iii) excessive charges or unnecessary services.

In my practice, I have seen physicians and other licensed professionals (including nurses) receive a letter from the OIG proposing an exclusion from participation in Federal health care programs following a suspension of their professional license or after a misdemeanor or felony conviction or after being convicted of a drug crime.

In cases where exclusion is permissive, it is recommended to provide the OIG with a clear and detailed response as to why the exclusion should not be imposed. Under certain circumstances, the OIG may choose not to impose exclusion. In other instances, the OIG will impose exclusion for a specific time period, for example, during the time period that the professional’s license is suspended.

If you receive a notification from the OIG proposing an exclusion, experienced legal counsel can assist you to formulate and file a timely response.

As always, if you have any questions about this post, the State Medical Board of Ohio or the unintended consequences of a Medical Board disciplinary action, feel free to contact the attorneys at the Collis Law Group at 614-486-3909 or send me an email at beth@collislaw.com

Medical practice in Ohio, State Medical Board of Ohio, Uncategorized

Being Investigated by the Medical Board? When to hire an attorney

I am often asked by physicians when is the best time to hire an attorney if they are being investigated by the State Medical Board of Ohio. The short answer is, the sooner the better.

The Medical Board is a governmental body that is established to regulate the practice of medicine in Ohio. As a regulatory agency, the Medical Board is required to investigate all complaints that are received related to physicians.

The Medical Board will assign an investigator to collect initial information related to the complaint. The investigator may request to meet with the physician to ask questions about the complaint. The Medical Board has the authority to subpoena medical records, to send the physician Interrogatory questions (questions the physician must respond to under oath), and may order the physician to a Deposition at the Medical Board office.

Any and all information submitted to the Medical Board or to the Medical Board’s investigator may be used as evidence to sanction a physician. Occasionally, physicians will speak with investigators, respond to Interrogatory questions, and even attend a Deposition without legal counsel. Many physicians believe that if they have “nothing to hide” they see no reason to retain an attorney. This is often a mistake.

The value of hiring experience legal counsel BEFORE you provide any information to the Medical Board is to help guide the physician through the investigative process, to help the physician understand all questions that are asked, and to assist the physician to provide information only as to what is being asked (and not irrelevant information and/or emotional or argumentative commentary).

Even if the physician believes the investigation is meritless, they still have a duty to cooperate in the investigation. The Board is required to investigate all complaints and has the authority and ability to close meritless complaints. However, by failing to provide clear, accurate, and timely responses to the Medical Board, the physician can exacerbate and/or extend the investigation. By arguing with investigators or providing non-responsive or argumentative replies to the Medical Board, the physician runs the risk of the investigator continuing the investigation or including in their investigation information which could have a negative impact for the physician.

The Board has no time limit to complete an investigation and often investigations can drag out for years.

In addition, once the physician responds to questions from the Medical Board, it is nearly impossible to “change your story”. Therefore, prior to responding to a Medical Board investigation, the physician should know and understand the law as it relates to the questions they are being asked. If the physician is not in compliance with the law, they should have a plan in place as to HOW they will come into compliance. Therefore, the sooner the physician retains experienced legal counsel, the more assistance legal counsel can provide.

Generally speaking, if the physician chooses to meet with the Medical Board investigator, respond to Interrogatory questions, and/or attend a Deposition without legal counsel, there is far less that legal counsel can do to assist the physician if the Medical Board institutes a disciplinary action.

I have also been asked if retaining legal counsel makes the physician look “defensive”. In my experience, the Medical Board respects the assistance of experienced legal counsel and understands that the entire investigative process is smoother when the physician is represented and informed.

As always, if you have any questions about the State Medical Board of Ohio in general or this blog post, please contact me at Beth@collislaw.com, check our firm website at http://www.collislaw.com or call to speak with one of the attorneys at the Collis Law Group, LLC at 614-486-3909.

Uncategorized

Ohio Physicians…Emeritus registration is an honorable and practical status following your retirement from the practice of medicine in Ohio.

Many physicians struggle with retirement. Many physicians envision practicing medicine until the day they die because they view medicine not only as their job, but as their way of life, identity, and calling.

I am aware of physicians who have lived outside Ohio or have not practiced in Ohio for many years who nevertheless continue to maintain an active Ohio medical license. However, to maintain an active medical license in Ohio, a physician must keep up to date with costly continuing education hours and renewals, and other legal and administrative requirements, the failure of any of which to adhere to could subject the physician to costly and stressful investigation and/or discipline by the State Medical Board of Ohio (“Board”). Additionally, even if a physician voluntarily allows their Ohio medical license to expire or lapse, the Board retains the legal right to institute a disciplinary action against the physician’s Ohio medical license for violation of certain laws or rules.

There is a simple way to avoid these problems. Under Board administrative rule 4731-22, a physician licensed to practice medicine and surgery in Ohio for at least ten years who declares that he or she is retired from active practice may apply to the Board for emeritus registration. For purposes of emeritus registration, “retired” is a status that means an individual has no active license in another state, or agrees in the emeritus application that he or she will not apply for renewal or reinstatement of any license held in another state. The physician may apply for emeritus registration by indicating on his or her biennial registration form or in written correspondence to the Board if he or she is in fact retired from active practice of medicine and surgery. To be eligible for emeritus status, the physician must also not have been the subject of disciplinary action in Ohio resulting in the revocation, suspension, probation, reprimand, or any other limitation of the physician’s license to practice.

Emeritus registration is not a license to engage in the practice of medicine and surgery and emeritus registrants may not engage in, or hold themselves out to others as actively engaged in, the practice of medicine and surgery. However, emeritus registrants may refer to themselves as doctor, if previously licensed to practice medicine and surgery.

Additionally, emeritus registrants are not required to comply with the Board’s continuing education requirements and also are exempt from renewal and renewal fees.

An emeritus registrant may apply to change back to active practice under conditions specified in the Board’s rules.

Emeritus registration is also available for practitioners licensed to practice osteopathic medicine and surgery, podiatric medicine and surgery, massage therapy, or cosmetic therapy in Ohio.

Be proactive. If you are ready to retire from the active practice of medicine and surgery in Ohio, consider applying for emeritus registration. Emeritus registration offers an honorable and practical status for a physician retiring from the active practice of medicine and surgery.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please feel free to contact me at Beth@collislaw.com or 614-486-3909 or check out our firm website at www.collislaw.com.

Uncategorized

Physicians should never examine a patient without a chaperone present

When examining a patient, a physician should always have a chaperone present in the room. The policy of the Medical Board has been to require a chaperone in the room when examining a patient of the opposite gender and when examining a patient in intimate areas of their body (such as a breast or vaginal examination).

However, after representing physicians before the Medical Board for nearly twenty years, I recommend that physicians have a chaperone present in the room during any patient examination. The chaperone is there to witness the examination. The chaperone represents the physician.

Often, I have had physicians tell me that they do not have a chaperone in the room because the patient brought a parent, spouse, friend or child with them to the examination. This is a mistake. If the patient alleges inappropriate conduct on the part of the physician, the friend or family member will not defend the physician and will support the statements of the patient.

Often, physicians tell me that they do not have the staff support to have a chaperone with them at all times when examining patients. My advice to them is that they cannot afford to NOT have a chaperone present.

If a complaint is made to the Medical Board by a patient that a physician touched them in an inappropriate manner during a medical examination, the Medical Board will open an investigation. The investigation can span many months or even many years (there is no statute of limitations for a Medical Board investigation). Without a chaperone present to testify on behalf of the physician, it is a simply a case of “he said – she said”, which is difficult for a physician to defend.

Patients have also been known to file police reports and to press criminal charges against physicians for conduct that took place during an examination, as well as filing civil law suits against physicians.

Physical examinations can be intimidating, embarrassing and occasionally uncomfortable for patients. It is always best to continue to explain to the patient what is taking place during the examination to alleviate their fears and concerns. However, it is also imperative that the physician have a chaperone present in the room to observe the conduct of the physician AND the patient.

The name of the chaperone should also be noted in the patient’s file as evidence that they were present during the examination. It is also recommended when conducting examinations of patients in a hospital setting to have a floor nurse present in the room during the examination.

As always, if you have any questions about this post or the State Medical Board of Ohio in general, please contact one of the attorneys at the Collis Law Group, LLC (formerly Collis, Smiles & Collis, LLC) at 614-486-3909 or contact me at beth@collislaw.com.

State Medical Board of Ohio

The Hippocratic Oath: A Blueprint For Certain Legal Requirements Applicable to Ohio Physicians

The Hippocratic Oath (“Oath”) is arguably the most widely known ancient Greek medical text. The Oath governs ancient Greek physicians’ professional and ethical behavior. Although written approximately 2,500 years ago, certain standards in the Oath are reflected in current legal requirements concerning Ohio physicians’ medical practice and behavior.

This is a literal translation of the original version of the Oath:

I swear by Apollo Physician and Asclepius and Health and Panacea and all the gods and goddesses, making them witnesses, that I will make complete this oath and this written covenant according to my ability and discernment:

–To regard my teacher of this art as equal to my parents and to share my livelihood (with him), and to make a contribution to him when he is in need of a debt, and to judge his offspring as equal to my brothers in manhood, and to teach this art – if they want to learn it – without wage and written covenant (to them), to make an imparting of the set of rules and lecture and all the rest of instruction to my sons and those of my teacher, and to those pupils who have been indentured and who have taken an oath according to the medical law, but to no one else.

-I will use diets for the assistance of the sick according to my ability and discernment; but also to keep away injury of health and injustice.

–I will neither give any deadly drug, having been asked for it, nor will I guide the same advice. Similarly, I will not give an abortifacient pessary to a woman. In purity and in holiness I will maintain my life and my art.

-I will not use the knife, not even on those suffering from the stone, but I will give way to those who are practitioners of this work.

–And as many houses as I may go into, I will go in for the assistance of the sick, being free from all voluntary injustice and mischief and the rest, even abstaining from sexual pleasures of both female and male persons, both free and slaves.

-That which I may see or hear during treatment, or even outside of treatment concerning the life of men, which must not in any way be divulged outside, I will not speak, regarding such things to be unutterable.

And so may it be to me making complete my oath and not making it of no effect that I enjoy the benefits of my life and art and be honored by all men for time eternal; but may it be the opposite of this to me transgressing and swearing falsely.

The Oath taken today has been revised from the above original text. Although there are portions of the original Oath which are no longer applicable or sworn to by physicians, there are interesting parallels between certain standards in the original Oath and the present-day laws in the Ohio Revised Code (“ORC”), pertaining to Ohio physicians’ medical practice and behavior, the violation of which subjects a physician to disciplinary action by the State Medical Board of Ohio (“Ohio Medical Board”).

No Harm To Patients

The Oath provides: “I will use diets for the assistance of the sick according to my ability and discernment; but also to keep away injury of health and injustice.” I interpret this provision generally to require the ancient Greek physician (i) to use dietary regimens to assist people who are sick, (ii) not to harm their patients, and (iii) not to do any injustice to their patients.

ORC §4731.22 authorizes the Ohio Medical Board to discipline a physician based acts would could result in patient harm including but not limited to:

ORC §4731.22(B)(2): Failure to maintain minimal standards applicable to the selection or administration of drugs, or failure to employ acceptable scientific methods in the selection of drugs or other modalities for treatment of disease;

ORC §4731.22(B)(3): Selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes;

ORC §4731.22(B)(6): A departure from, or the failure to conform to, minimal standards of care of similar practitioners under the same or similar circumstances (whether or not actual injury to a patient is established); and

ORC §4731.22(B)(18): Violation of any provision of a code of ethics of the American medical association; and/or

ORC §4731.22(B)(29): Failure to use universal blood and body fluid precautions established by Ohio Medical Board rule.

No Injustice To Patients

ORC §4731.22 also authorizes the Ohio Medical Board to discipline a physician based on an act which evidences an injustice to a patient including but not limited to:

ORC §4731.22(B)(1): Permitting one’s name or one’s certificate to practice or certificate of registration to be used by a person, group, or corporation when the individual concerned is not actually directing the treatment given;

ORC §4731.22(B)(5): Making a false, fraudulent, deceptive, or misleading statement in the solicitation of or advertising for patients; in relation to the practice of medicine and surgery;

ORC §4731.22(B)(7): Representing, with the purpose of obtaining compensation or other advantage as personal gain or for any other person, that an incurable disease or injury, or other incurable condition, can be permanently cured; and/or

ORC §4731.22(B)(8): The obtaining of, or attempting to obtain, money or anything of value by fraudulent misrepresentations in the course of practice.

Although the requirement of the Oath to, “keep away injury of health and injustice” is phrased more broadly than the specific requirements in the ORC, a parallel between the requirements of the Oath and the ORC is apparent. The dictates imposed by both the ancient Greek caregivers and the Ohio legislature evidence important standards that a physician do no harm to the patient and promote the just (ie, honest and truthful) relationship between the physician and the patient.

Sanctity Of Life

The Oath provides: “I will neither give any deadly drug, having been asked for it, nor will I guide the same advice. Similarly, I will not give an abortifacient pessary to a woman. In purity and in holiness I will maintain my life and my art.” The requirements (i) not to give or recommend any deadly drug, (ii) not to induce an abortion, and (iii) for the physician to hold his or her own life in purity and holiness, individually and collectively, support the notion that ancient Greek physicians held human life as sacred.

ORC §4731.22(B)(3) authorizes the Ohio Medical Board to discipline a physician for selling, giving away, personally furnishing, prescribing, or administering drugs for other than legal and legitimate therapeutic purposes. Additionally, assisted suicide is against public policy in Ohio (ORC §3795.02(A) and is required to be enjoined by a Court of Common Pleas (ORC §3795.02(B)). Consequently, ORC §4731.22(B)(37) authorizes the Ohio Medical Board to discipline a physician for assisting suicide.

Subject to certain express conditions and exceptions in Ohio law beyond the scope of this article, ORC §4731.22(B)(23) authorizes the Ohio Medical Board to discipline a physician for performing or inducing an abortion upon a pregnant woman.

No Sexual Misconduct

The Oath provides: “And as many houses as I may go into, I will go in for the assistance of the sick, being free from all voluntary injustice and mischief and the rest, even abstaining from sexual pleasures of both female and male persons, both free and slaves.

OAC §4731-26-02(A) authorizes the Ohio Medical Board to discipline a physician for engaging in sexual misconduct with a patient.

Confidentiality

The Oath provides: “That which I may see or hear during treatment, or even outside of treatment concerning the life of men, which must not in any way be divulged outside, I will not speak, regarding such things to be unutterable.”

ORC §4731.22(B)(4) authorizes the Ohio Medical Board to discipline a physician for willfully betraying a professional confidence.

Conclusion

The standards in the Oath applicable to ancient Greek physicians to do no patient harm, to have a just patient relationship, to take no act contrary to human life, to abstain from sexual misconduct with a patient, and to protect patient confidential information, are reflected in present-day legal requirements applicable to Ohio physicians’ medical practice and behavior.

That the Oath is recited in medical schools even today (See: http://medicine.osu.edu/news/archive/2012/08/21/reciting-the-hippocratic-oath-a-family-centered-tradition.aspx) is a testament to the enduring verities contained in the Oath.

As always, if you have any questions about this post or the Ohio Medical Board in general, please contact Collis, Smiles & Collis, LLC or Beth Collis at 614-486-3909 or Beth@collislaw.com.

State Medical Board of Ohio

Ohio Medical Board has adopted New Rules Related to Office Based Opioid Treatment

The State Medical Board of Ohio has adopted new rules related to Office Based Opioid Treatment (“OBOT”). The new news take effect January 31, 2015. The new rules require specific protocols, pretreatment examinations, and ongoing physician face-to-face examinations, testing and individualized treatment plans. A copy of the new rules can be found at: http://med.ohio.gov/pdf/rules/NewRules/4731-11-12-eff-1-31-15.pdf.

The new rules include but are not limited to:

Prior to providing OBOT, the physician must conduct an assessment of the patient that meets the requirements of the rule.
The physician must practice in accordance with one of the protocols listed in the rule, and the diagnosis of an opioid disorder must be made utilizing the criteria in the DSM, 4^th or 5^th edition.
The physician must develop an individualized treatment plan for the patient, require the patient to actively participate in appropriate behavioral counseling or treatment for addiction, and provide ongoing toxicological testing.
The physician’s prescribing of the medication must comply with requirements that include, but are not limited to, prescribing only drugs specifically approved by the FDA for use in maintenance and detoxification treatment, prescribing no more than 16 milligrams of medication daily for a patient unless specified requirements are met, and accessing OARRS for each patient no less frequently than every 90 days.
The physician must complete Category I CME related to substance abuse and addiction every two years, which will be accepted as part of the CME requirement for license renewal.

The above summary highlights certain requirements of the new rules and is not a substitute for the new rules. The new rules can be found at: http://med.ohio.gov/pdf/rules/NewRules/4731-11-12-eff-1-31-15.pdf.

As always, if you have any questions regarding this post or the State Medical Board of Ohio in general, please contact one of the attorneys at Collis, Smiles and Collis at 614-486-3909 or email Todd@collislaw.com.