Tag Archives: National Practitioner Data Bank

Advantages of being represented by an attorney in IDFPR proceedings

 

The Illinois Department of Financial and Professional Regulation (IDFPR) is responsible for the regulation and oversight of professionals in Illinois. The IDFPR has a duty to the people of the State of Illinois to ensure that its licensed professionals meet the guidelines and standards of professional practice. In healthcare practice, like others, when an individual files a complaint about a licensed healthcare practitioner, the IDFPR has a duty to investigate the claim and engage in disciplinary proceedings where appropriate. Many complaints made against healthcare professionals are disposed of and no action is taken. If and when an Illinois-licensed healthcare professional receives notice of an incident, it is a best practice to hire be represented by an experienced professional licensing attorney during the process.

IDFPR investigations and proceedings are conducted pursuant to administrative legal standards and its individual policies and procedures.

Administrative proceedings and the policies and procedures involved are unique to each agency. The IDFPR uses its own methods and rules to conduct investigations, hearings and disciplinary proceedings. Since the process is unique, it can beyond the practice area scope of general legal practitioners. Attorneys in healthcare law and licensing practice have unique experience in representing healthcare practitioners before the IDFPR.

Michael V. Favia knows how IDFPR investigators and prosecuting think because he is a former Chief of Prosecution for the agency, when it was known as the Illinois Department of Professional Regulation. Favia knows how and when to resolve a licensing case in the best interests of the licensed healthcare professional.

The best case scenario is being diligent and avoiding professional practice investigations and potential outcomes that could damage a healthcare practitioner in their career and reputation.

There are further and other implications of licensing and disciplinary decisions. For example, discipline in Illinois is reported to the National Practitioner Databank, and an adverse decision in Illinois could trigger investigation and discipline in other states if the individual holds licenses in more than one state.

Licensed healthcare professionals have a duty to report certain occurrences, as a conditional requirement for maintaining a valid license to practice. How and when information is communicated to the IDFPR or relevant state board or agency can be the difference between diligence and discipline.

Preventing a future IDFPR investigation is another goal Favia uses when working in healthcare law and litigation. In medical malpractice cases, the outcome of a lawsuit can directly lead to an investigation.

About us: Michael V. Favia & Associates, P.C. is a health law and litigation firm in Chicago representing individuals, healthcare professionals and organizations with civil legal matters as well as professional licensing and regulation.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent private individuals as well as healthcare professionals in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. Michael V. Favia & Associates is available at (773) 631-4580. Please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

Telemedicine: Illinois licensing issues

Telemedicine and new telehealth options are available to an increasing number of patients. In addition to hospitals and health care organizations, direct health care service providers are adopting telemedicine into their medical practices to serve and an increased number of patients. Telemedicine utilizes mobile apps and software allowing doctors and patients to meet in a virtual setting for certain types of services. In other settings, when meeting with your regular doctor, you might use mobile health care technology to bring in a specialist who would otherwise not be available due to schedules and distances. Routine doctor-patient interactions, such as follow up visits and general maintenance can be conducted using telemedicine, saving time and resources for patients who would otherwise need to drive distances to see their doctor. As more people learn of the benefits of telemedicine, there may be a patient preference to see a doctor who can see them in person or by mobile health care technology. In light of the benefits of telemedicine, there are certain legal issues arising in mobile health care. Practitioners should be aware and mindful of licensing issues.

Licensing issues involved in the practice of Telemedicine

Illinois law speaks of telemedicine within the context of the practice of medicine. Anyone practicing medicine and using telemedicine technologies must be licensed by the State of Illinois, and anyone engaging in the practice of telemedicine without an Illinois-issued medical license may be subject to penalties.[i] The general rule is that only an Illinois-licensed doctor may offer services, using telemedicine, to a patient located in Illinois. There are some exceptions to licensing rules, as it applies to patients located outside the State of Illinois.[ii]

Telemedicine does not include the following:

  1. periodic consultations between a person licensed under this Act and a person outside the State of Illinois;
  2. a second opinion provided to a person licensed under this Act; and
  3. diagnosis or treatment services provided to a patient in Illinois following care or treatment originally provided to the patient in the state in which the provider is licensed to practice medicine.

The Interstate Medical Licensure Compact[iii] was adopted into Illinois law on July 20, 2015. The Compact allows physicians to become licensed in multiple participating member states. The state where the medical practice takes place is the state where the patient is located at the time of the first physician-patient encounter, and the physician is subject to the jurisdiction of the state medical board in that state. Where a physician may become licensed in several Compact states, an unfortunate event, such as a medical malpractice lawsuit and settlement could lead to more problems for a physician, making telemedicine a potential benefit and burden.

Pitfalls of multistate licensing and practice

In the event of a malpractice settlement, the insurance provider presents the case disposition information to the National Practitioner Data Bank, the clearinghouse for state medical practice information designed to protect the public from unfit doctors moving from state to state to avoid a negative practice history. If a doctor licensed in Illinois, is also licensed in other Compact states, all the state medical licensing boards may be notified of a malpractice settlement. While Illinois may not take disciplinary action against a doctor for settling a malpractice case, there is no telling what the boards in other Compact states may decide with respect to licensure in their state. If one of the states disciplines the physician, more states may get involved and investigate for purposes of discipline.

While there are plenty of patients for doctors to serve in outlying areas in Illinois, there is an increasing interest in telemedicine among individual providers who can better reach their practice goals through mobile health care technologies. Whether staying within the Illinois boarder or practicing across state lines, there are licensing considerations that may present burdens along with the benefits of telemedicine.

Michael V. Favia and Associates, P.C., works with physicians interested in bringing telemedicine into their practice, and advises doctors and organizations about licensing as it intersects with mobile health care.

Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent licensed physicians in all types of litigation and administrative matters involving licensing and regulatory agencies.

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

[i] 225 ILCS 60/49.5(b)

[ii] 225 ILCS 60/49.5(c)(1)-(3)

[iii] House Bill 3680 Enrolled, Public Act 099.0076

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Court rules hospital must disclose confidential physician credentialing records

The Illinois Supreme Court recently ruled that a physician’s application file and their data bank report information was subject to discovery in a plaintiff’s medical malpractice lawsuit alleging negligent credentialing. Hospitals have a duty to protect their patients against careless and incompetent physicians. Credentialing is the process through which a healthcare provider collects and verifies the professional qualification of a health care practitioner, including but not limited to relevant training, licensing, certification and registrations with health care regulatory boards and agencies. Negligent credentialing lawsuits involve the failure of a health care provider to meet its duty to conduct and maintain proper credentialing practices in connection with licensed health care professionals practicing within their health systems. In the event of a medical malpractice claim, the physician providing health care services might be negligent, but the health system might also be liable if they were negligent themselves, in the credentialing process.

Lawsuits arise out of medical malpractice claims where physician credentialing is at issue.

Credentialing of licensed health care professionals might take place at the direction or requirement by insurance companies, regulatory agencies, and health care administrations. It is common to re-credential a licensed physician following a medical malpractice claim; failure to verify a credential status following a claim for medical malpractice may expose the health care system to its own negligence and liability.

In the instant case, Klaine v. Southern Illinois Hospital Services (2016 IL 118217), the negligent credentialing medical malpractice lawsuit was filed against the physician and two hospitals where the physician was working. In the process of pre-trial discovery, the hospital responded to a discovery request from the plaintiff and responded with the production of approximately 2,000 pages of documents. Not included in the discovery response were two groups of documents, “which contained three of the physician’s applications submitted in 2009, 2010 and 2011 (Group Exhibit F) and “procedure summaries and case histories” (Group Exhibit J), arguing that they were privileged.[i]

Claims of privilege, in the discovery process, are asserted by hospital defendants but can be overruled by courts, and in this case, the physician’s application file and data bank report was deemed discoverable.

The hospital in this case, asserted that the withheld documents were not subject to the discovery process, arguing they were privileged pursuant to the Illinois Medical Studies Act[ii] (MSA) and the Health Care Professional Credentials Data Collection Act[iii] (Credentials Act).

The Illinois Supreme Court held that the information subject of the Credentials Act is confidential, but it is not privileged, for purposes of a medical malpractice negative credentialing lawsuit. Likewise, the court ruled against the defendant’s argument that the MSA precluded the discovery, noting that “confidential” is not the same as statutorily privileged. The physician’s applications, procedure summaries and case histories were ruled discoverable.

Information about physician’s history of practice and any reports of medical malpractice claims, settlements and regulatory decisions involving matters such as discipline, are maintained in the secure National Practitioner Data Bank (Data Bank). Over the hospital’s claims that the Data Bank information was privileged under the Health Care Quality Improvement Act[iv], the Illinois Supreme Court found the Data Bank information was discoverable and stated, “We believe it is clear that information reported to the NPDB, though confidential, is not privileged from discovery in stances where, as here, a lawsuit has been filed against the hospital and the hospital’s knowledge of information regarding the physician’s competence is at issue.[v]

Professional licensing and health care law and litigation attorney, Michael V. Favia asserts there are practices through which the hospital could have better insulated itself from exposure in this type of case.

Michael V. Favia states, “This case clearly set forth the unique intricacies of properly maintaining internal hospital records so that they are protected and not discoverable under various fact scenarios involving professional staff and/or internal risk management protocols.  Attorneys working in health law and in particular those handling hospital related matters should become very familiar with the details and judicial analysis of this case.”

Michael V. Favia and Associates, P.C. represents individual physicians and health care organizations in the Chicago area with a variety of legal matters. With offices conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates, please visit www.favialawfirm.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter. You can also review endorsements and recommendations for Michael V. Favia on his Avvo.com profile and on LinkedIn.

[i] The National Law Review, Illinois Supreme Court Rules Physician’s Application File and Data Bank Report Information Discoverable in Negligent Credentialing Lawsuit, by Michael R. Callahan, Feb. 22, 2016.

[ii] 735 ILCS 5/8-2101.

[iii] 410 ILCS 517/1 et seq.

[iv] 42 USC § 11137(b)(1).

[v] See HNi above.

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Challenges for health care professionals reported in the National Practitioner Data Bank

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The National Practitioner Data Bank (NPDB) is a federal information collection program, a part of the U.S. Department of Health and Human Services, designed to ensure health care consumers receive quality health care, patient safety, and are protected from fraud and abuse in the health care industry. This information kept and shared with authorized users includes negative health care professional disciplinary information, malpractice awards, loss of license or exclusion from participating in Medicare or Medicaid. The benefit of information sharing is measured in the efficiency in which the state agencies licensed to use the data bank can catch potential threats to the public, preventing health care professionals from having trouble in one state and leaving for another to start over with a clean slate. There are challenges however, when a health care professional is licensed in several states and there is an occurrence in one state and all the other states are notified, potentially triggering a chain reaction of inquiries among licensing and regulatory agencies.

Information collection and sharing is not new, but it is a more streamlined process today.

The United States Congress created the National Practitioner Data Bank with the intent to improve the quality of health care services while protecting the public from fraud and abuse. In 2010, when Congress voted to approve the Affordable Care Act, the NPDB was combined with the Healthcare Integrity and Protection Data Bank (HIPDB), which was originally established in 1996 in the Health Insurance Portability and Accountability Act (HIPAA). HIPDB was established to combat health care fraud and abuse, and served to collect and share information the way the NPDB does today.[i]

Reports to the National Practitioner Data Bank are “records of actions taken by authorized organizations regarding health care practitioners, entities, providers, and suppliers who do not meet professional standards.[ii]” An authorized report can include information concerning settlements and payment in medical malpractice cases in addition to negative action by health care organizations or state licensing boards in connection with the delivery of health care services, meaning a reprimand, loss of privileges, suspension, revocation and so forth. Medical malpractice reports are a concern of any licensed health care professional whose decision in whether to settle or continue defending against a complaint for medical malpractice due to concerns that paying a settlement will jeopardize the doctor’s status in the NPDB.

Licensure in multiple states can be a concern for health care professionals with reports on the NPDB.

If a health care professional settles a medical malpractice case, and they are licensed in multiple states, there could be state inquiries arising out of all the states in which the individual holds a medical license. It is possible that in the licensing agency, in the state where the medical malpractice case took place, is aware, investigates and elects not to discipline the health care professional. It is also possible that a neighboring state agency, also becoming aware of the malpractice cases through the NPDB, investigates and takes adverse action against the health care professional, such as suspending the individual’s license. That suspension could be the trigger for a domino-type effect in all the states in which a health care professional is licensed to practice their craft.

Health care professionals defend against claims and complaints to avoid reports on the NPDB.

Attorneys and consultants such as Michael V. Favia and the Illinois Professional Licensing Consultants work with health care professionals who face concerns about long-term impacts of actions that could damage their reputation and ability to earn income when reports are made to the NPBD. When negative information is reported through the NPDB, it can cost a health care professional significant time and money to protect their license to practice and make a living. Knowing the benefits and liabilities arising out of the NPDB is important, and health care professionals should be keenly aware of the NPDB and how it is used in the health care industry among the states.

Michael V. Favia & Associates offices are conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] National Practitioner Data Bank website, HIPDB Archive.

[ii] National Practitioner Data Bank website, Reporting to the NPDB

Podcast: Medical Malpractice and Professional Licensing Issues with Michael Favia

Healthcare law and litigation attorney Michael V. Favia recently spoke at a national audience of medical malpractice attorneys on professional licensing issues that can affect their clients.

Healthcare law and litigation attorney Michael V. Favia recently spoke to a national audience of medical malpractice attorneys on professional licensing issues that can affect their clients. He shares similar information on this podcast considering medical malpractice and professional licensing. 

The Illinois Professional Licensing Consultants is a group of highly experienced attorneys and investigators who previously worked for the I.D.P.R. will represent and/or defend licensed    professionals in cases involving the Illinois Department of Financial and Professional            Regulation, Illinois Department of Public Aid and Illinois Department of Public Health. In this monthly podcast series our attorneys and consultants will share news, tips and resources.

CLICK/TAP HERE TO LISTEN TO THE PODCAST ANYTIME

Topics covered in this 30 minute program:

  • Introducing Michael Favia and his experience in medical malpractice and how it connects to professional licensing;
  • The potential licensing issues doctors face when medical malpractice cases are settled;
  • About National Practitioner Data Bank and how it can that affect licensed physicians and healthcare professionals;
  • How medical malpractice attorneys work with licensing consultants to better serve healthcare professional clients;
  • Industry trends in healthcare and licensing that of which our listeners should be aware.

Michael V. Favia He is a former Asst. Illinois Attorney General and the Chief Prosecutor for the Illinois Dept. of Professional Regulation (IDPR), now known as the Illinois Dept. of Professional and Financial Regulation (IDFPR). Favia is the owner of a Professional Licensing Consulting Company where he and affiliated former prosecutors, investigators and professional licensing board members assist licensed professionals in their business, regulatory and IDFPR related matters.

Visit our Illinois Professional Licensing Consultants website for more information. You may also contact Michael V. Favia for more information by e-mail at favia@lawyer.com or dial (773) 631-4580.