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What not to do at a nursing license board hearing

If you make a living as a nurse, a time may come when you receive notification that someone made a complaint against you, even if you believe the complaint to be meritless. If you become the subject of an investigation by the Texas Board of Nursing, how you respond to the complaint and what you do in your hearing are likely to factor into any disciplinary actions taken against you.

As important as knowing what to do at a nursing board hearing is understanding what not to do that might potentially hurt your case, so know that if you receive word that you are the subject of a complaint or investigation, be sure not to:

Have you been accused of unprofessional conduct as a nurse?

Let us say that you relocated to Texas to take a position as Nurse Practitioner with a small physician's group. No sooner had you settled in when your supervisor told you to make a change to a medical record so that it would support a certain billing code. You followed instructions, but that was a big mistake.

Changing a medical record is a fraudulent activity, and now your nursing license is in jeopardy. Fortunately, experienced legal help is available.

Deadline for meeting new home health requirements postponed?

In mid-January, the Centers for Medicare & Medicaid Services published a home health agency final rule outlining new minimum standards for home health agencies participating in Medicare and Medicaid.

The new rule, which includes revised training requirements for staff on competent care standards and patient rights, was supposed to take effect this summer, on July 13, 2017, but last week the CMS proposed to delay the effective date for six months, until January 13, 2018.

The CMS said the proposal was made after it was clear from rule comments that industry stakeholders needed more time to comply, including making necessary adjustments to resource allocation, staffing and perhaps infrastructure.

Can a nurse lose their license for DWI?

Being charged with a DWI is embarrassing, expensive and stressful. But if you are a nurse who has been convicted of a DWI while you were off duty, then the stakes are even higher. Your livelihood could be at risk.

After being convicted of drunk driving, it is likely that you will be investigated by the Texas Board of Nursing. It is not likely that a first conviction will result in disciplinary actions, but it could if the BON finds evidence that questions your fitness to care for patients.

Being naive is no defense to Medicare fraud

Another doctor has been convicted for playing a part in a multi-million-dollar Medicare fraud scheme. The guilty verdict shows that even being "extremely naïve" is not a valid defense to Medicaid fraud charges.

The situation involved a $13 million operation in Houston in which marketers were used to find people to pose as patients and have unnecessary tests performed so that the government could be charged.

The marketers were supposedly paid $100 kickbacks for every "patient" they recruited. The so-called patients were paid $50 for their cooperation, the Houston Chronicle reported.

What a Texas nurse facing disciplinary action can expect

Anytime a LVN or RN faces a disciplinary proceeding with Texas Board of Nursing (BON), he or she should immediately contact an attorney who is well-versed in the processes and professionals involved. With your license in jeopardy, you cannot afford to take on the matter alone or with someone who is not qualified to help you.

Here is what you can expect:

It starts with a complaint: The Texas BON receives more than 16,000 complaints about nurses each year. Not all of the complaints result in an investigation or disciplinary proceeding, though. The complaints that do not lead to an investigation or disciplinary proceeding often:

  • Lack information about the nurse's identity
  • Are out of the BON's jurisdiction
  • Are determined to involve "minor incidents"
  • Do not constitute violations of the Nursing Practice Act (NPA)

If an investigation does take place, nurses need to know that they have due process rights, which means that they have a right to formal proceedings before they can be disciplined or lose their licenses. They also have the right to an attorney during the process, who can help defend nurses against BON actions.

Physician coding and billing compliance more important than ever

Coding and billing fraud are once again major targets for the Office of the Inspector General (OIG) and the Department of Justice.

There have been several high-profile cases involving coding and billing for physician services in recent months, and providers should make sure that their practices are in compliance with the law to avoid government audits.

Even though there are many tools marketed to physicians groups and hospitals that are intended make sure that medical coding and claims submissions are in compliance with Medicare and requirements from private payers, these tools may be giving health care professionals a false sense of security.

What to expect during the Texas Medical Board Enforcement Process

Doctors may encounter licensing issues at any time during their careers, and they are stressful whenever they arise. Issues may include allegations involving:

  • Standard of care violations
  • Criminal charges
  • Drugs or alcohol use
  • Stark law or anti-kickback violations

If you have a received a letter from Texas Board of Medical Examiners, then your career may be on the line. Facing disciplinary action by the Texas Board of Medical Examiners is not a situation to take lightly, and it is not something that you will want to handle alone.

Here is what the process generally involves:

Massive Fraudulent Billing Sting Prosecutes Over 300

The Justice Department recently conducted one of the largest take-downs in history against medical providers, prosecuting fraudulent activity in clinics, pharmacies and other medical centers across the United States.

Across the country, the sting charged over 300 defendants, including over 60 medical professionals, 28 of which were doctors, for over $900 million in false billing. These billings were largely for services that were never provided or that were unnecessary.

Things you should know if you're considering a venture in health care

Health care is one of the strongest sectors in the United State's economy. In a moment when the industry is adapting to new rules and regulations, there is a significant opportunity for new players to break into the market with transformative ideas and innovation.

Forbes recently highlighted several tips for those considering launching a health care venture or exploring the possibility to starting a practice:

Know the new rules - The economics of health care are changing rapidly. Study the changes and know how the money flows through the system. Not only can this help you identify gaps in the market and areas in which you can make money, it can help you avoid costly mistakes that could ultimately end your venture.

Develop technology that cuts costs - Given the new economics of health care, everyone throughout the industry is looking for ways to minimize expenses and cut costs. Identify ways to close some of the gaps and save practices money through technology or other innovation. Be aware that ensuring that your ideas will be effective may be harder than you think.

Identify reliable capital - Forbes reports that venture capital investments in health care technology have more than doubled in the last two years alone. Private equity is eager to take advantage of these money making opportunities. Work with a skilled health care law attorney to secure capital from a source that you can rely upon and partner with to expedite the growth of your venture.

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