Rivas Goldstein, LLPAustin Health Care Lawyer | Texas Medical Licensing Attorney2026-05-22T07:41:02Zhttps://www.rivasgoldstein.com/feed/atom/WordPressOn Behalf of Rivas Goldstein, LLP<![CDATA[Texas BON investigations: Safeguarding your license from day one]]>https://www.rivasgoldstein.com/?p=509432026-05-11T19:51:11Z2026-05-21T19:50:18Z can seem like a Texas Board of Nursing (BON) investigation can arrive without warning. These investigations can be triggered by a complaint from a patient, coworker, employer or family member, a charting issue or a medication variance. The first instinct for anyone that is accused of a mistake is to provide an immediate explanation. To send a quick email or make a quick phone call to help clear things up. It is important to refrain from this type of reflexive response. The following will explain why discretion is important and provide tips to help better ensure a positive outcome.
Why should nurses refrain from trying to explain the situation?
An initial response immediately following notice of an investigation can mean a response that focuses on emotion and urgency. Those conditions do not lead to the most well thought out explanation. A well meaning response can read like inconsistency when compared with records, policies and time stamps.Before any response, take a breath. Treat the situation like documentation for patient care. Precise. Limited. Accurate.Below are common traps that appear in early communications. Avoidance now protects options later.
Guessing details, including times, doses, sequence of events
Volunteering extra information beyond the specific allegation
Assigning blame to coworkers, supervisors, policies
Using absolutes such as “always” or “never”
Writing while upset, sleep deprived, pressured by management
These missteps rarely occur due to dishonesty but instead the result of trying to put together a quick response. This quick response will often stay with the case through completion. As a result, it is important that every response is well thought and accurate.
Why is the initial written response important?
The initial written response can shape the investigation. It frames the narrative and guides follow up questions. It can influence whether the case escalates, resolves or heads toward an informal conference. It can also become a permanent exhibit.A strong response generally focuses on verifiable facts, scope and standards. It avoids argument medical conclusions beyond your role and aligns with the record to show professionalism.The checklist below gives an idea of a general response, though the best is tailored to the details of the case:
Read the allegations carefully, respond only to each allegation
Build a timeline from records, policies, objective documentation
Use clear, neutral language, no speculation, no sarcasm
These steps can help to support credibility. A Texas BON investigation feels personal but the process is administrative. The safest response and path forward involves strategic patience. The initial written response serves as the foundation for everything that follows. By taking the time to build it carefully from the first day you can help to structure a defense to the allegations that protects your interests and future as a nurse.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Three important things to know about the crackdown on healthcare fraud in Texas]]>https://www.rivasgoldstein.com/?p=509422026-05-22T07:41:02Z2026-05-19T19:18:40Z state of Texas is continuing its crackdown on healthcare fraud through 2026. Earlier in the year, Attorney General Ken Paxton announced over 180 indictments for healthcare fraud in 2025 and a focus on continuing the efforts through 2026. Three important things for those in the healthcare industry in Texas to know about these efforts are discussed below.
#1: Local focus with federal reach
These efforts are using a combination of local and federal resources. For example, in collaboration with federal agencies Attorney General Paxton’s Medicaid Fraud Control Unit played a significant role in the largest healthcare fraud action in history. The federal effort included more than a dozen healthcare fraud schemes in operation in Texas as well as hundreds of millions in fraudulent billing throughout the nation.
#2: These efforts will continue through 2026
Attorney General Paxton was very clear that the state is not slowing down these efforts. In a recent announcement, he stated his office will continue to “bring the hammer down on fraudsters.”
#3: Those under investigation have options
Healthcare professionals dedicate their careers to helping others. False accusations of fraud can devastate reputations built over decades. It is important for those who find themselves facing such allegations to understand the basics of the process so they can begin to structure a response to the allegations. Healthcare fraud allegations often stem from billing errors, documentation issues or misunderstandings of complex regulations. A defense tailored to the case is important to help protect professional licensure, livelihood and reputation. When building a defense strategy, a review of the following can help:
Intent: It is often helpful to demonstrate that any billing irregularities resulted from honest mistakes rather than deliberate deception. Prosecutors will look to establish that the fraud was intentional.
Reasonable interpretation: Billing practices that reflect a reasonable interpretation of ambiguous regulations or coding guidelines can also serve as part of a defense strategy.
Reliance on professional advice: Gather evidence of advice from billing specialists, consultants or legal advisors when making coding decisions.
Inadequate evidence: Challenge the government's case by exposing gaps in their documentation or flaws in their investigative methods.
Good faith: A genuine attempt at honest billing practices that comply with applicable laws and regulations can also help.
Healthcare fraud defense requires attorneys who understand both medical practice and federal regulations. The right legal team can mean the difference between conviction and vindication. Your years of service to patients deserve protection from unfounded accusations.Texas healthcare providers are practicing in a strict enforcement environment and healthcare professionals are wise to recognize the gravity of this situation. A single billing error could trigger an investigation that threatens a career. Early action matters. The moment you receive notice of an investigation, your response begins shaping the outcome. Documentation of billing practices, evidence of good faith efforts and proof of reliance on professional guidance can all become critical elements of your defense.This enforcement wave will not subside in the near future. Healthcare providers should review their billing practices and ensure documentation supports every claim. Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Can your social media posts affect your nursing license in Texas?]]>https://www.rivasgoldstein.com/?p=509352026-04-29T02:08:44Z2026-04-29T02:08:44ZMany nurses operate under the assumption that their personal social media accounts exist entirely outside the scope of their professional lives. It's an understandable belief, but it's also a dangerous one. In fact, the Texas Board of Nursing (BON) holds you to a 24/7 standard of professional character. That standard doesn't clock out when your shift ends. Hence, ignoring it online could put your entire career at risk.
This is why understanding that standard is important. But it's just as important to understand how quickly your online activity can set off a formal review of your license.
How a single post can trigger an investigation
You may not realize how quickly a post can spark a formal investigation. Anyone, including a coworker, a patient or even a stranger, can file a complaint with the BON about your online activity. Once the board receives a complaint, it can open a formal review of your license. Depending on the findings, you could face a written reprimand, a fine, suspension or even license revocation. In fact, your social media presence is far more visible and consequential than you might expect.So what kinds of posts put you at risk? Knowing the specific behaviors the BON watches for can help you stay on the right side of the line.
Health Insurance Portability and Accountability Act (HIPAA) violations: Posting patient photos or describing a case in sufficient detail to make someone identifiable is illegal, even without disclosing a name.
Unprofessional conduct: Venting online about your employer, colleagues or patients can lead to termination and a formal BON report.
Boundary violations: Following, friending or engaging with patients on social media undermines professional boundaries. The BON treats this as a serious offense.
Damaging the profession: Posts that harm nursing's public reputation may prompt disciplinary action, even when the content feels personal.
Knowing what to avoid is a strong start. But if you've already posted something questionable, the next step is knowing how to protect yourself.
Protect the license you’ve worked hard to earn
A social media misstep doesn't have to define your career. Your nursing license represents years of hard work, sacrifice and professional dedication. Safeguarding it means staying informed, exercising discretion in what you share online and recognizing that you don't have to face a BON complaint on your own. The right guidance at the right time can make all the difference. When your livelihood is at stake, taking that first step toward getting answers is always worth it.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Pediatric care strain calls for focused burnout prevention]]>https://www.rivasgoldstein.com/?p=509362026-04-21T19:45:27Z2026-04-28T19:42:42Z are arguably facing more strain now than ever before. Add in the fact that hospitals are closing and fewer residents are choosing to specialize in this field and it seems there is no relief in site. As such, pediatricians are wise to review their current situation and implement measures to reduce the risk of burnout. The following tips can help.
Set boundaries that hold up under scrutiny
Chronic overextension within the pediatric field can lead to documentation gaps, missed follow-up and delayed test review. Those failures are predictable in a high-volume setting. A boundary plan reduces both clinical risk and licensing exposure.Before implementing changes, identify pressure points that repeatedly lead to rushed decisions, incomplete charting and skipped reassessment. Whether in a large hospital or small private practice, pediatricians should consider the following factors:
Maximum number of patients comfortable providing care for per day
Time needed for care coordination and record review
Involvement in nonessential committees and afterhour obligations
Push to implement necessary changes and clearly communicate expectations to leadership.
Protect yourself
Use confidential mental health care when needed. Address sleep, call burden and substance use risk early. If impairment is possible, seek evaluation through a physician health program. Early engagement can preserve licensure, prevent reportable events and reduce the risk of patient harm.
Consequences of burnout that can trigger licensing scrutiny
Physician burnout does not always stay confined to long shifts and quiet frustration — it can spill into professional conduct in ways that draw the attention of a state licensing board. When exhaustion, cynicism and impaired concentration affect documentation, clinical decision-making, patient communication or follow-through on safety protocols, physicians may face complaints, adverse event reviews or allegations of unprofessional conduct. Boards typically focus on patient protection, so patterns such as missed follow-ups, boundary lapses, disruptive behavior or suspected impairment can trigger investigations, required evaluations, mandated treatment or monitoring, and, in serious cases, probation, suspension or restrictions on practice. Burnout also increases the risk of errors and delayed reporting, which can complicate a physician’s response to an inquiry and escalate board involvement. By recognizing burnout early and seeking support through employee assistance programs, physician health programs or peer resources, clinicians can reduce risk and protect both licensure and patient care.Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Understanding the Texas Medical Board Complaint Process]]>https://www.rivasgoldstein.com/?p=509312026-04-21T21:34:17Z2026-04-09T16:31:59ZA complaint with the Texas Medical Board can affect your license and professional standing. Understanding the process helps you respond in a clear and timely way.
How a complaint begins
Anyone can file a complaint against a licensed provider. This includes patients, coworkers and members of the public. The Board only reviews matters within its authority.Complaints must include specific facts, dates and provider details.
What happens during initial review
The Board first determines if it has jurisdiction. Complaints outside its scope may be dismissed or referred to another agency.If the complaint qualifies, the Board notifies you. You must submit a written response and may need to provide records.
Stages of the TMB complaint process
Most cases move through structured phases. Each step builds the record the Board will rely on:
Initial review: The Board confirms jurisdiction and legal authority.
Preliminary investigation: Staff collect records and request your explanation.
Informal settlement conference: You may discuss possible resolution.
Formal hearing: A judge may hear the case if no agreement is reached.
Each stage carries weight. Early responses can influence how the case develops.
Possible outcomes and timelines
The Board may close the case if no violation is found. If evidence supports the complaint, discipline may follow. Common outcomes include:
Dismissal: No action taken.
Remedial Plan: Non-Disciplinary not reportable to the National Practitioner Data Bank.
Reprimand: A formal warning is issued.
Fines or education: You must complete corrective steps.
License action: Suspension or revocation may occur.
The process may take several months or longer. Public discipline can appear in professional databases.
Why this process carries real risk
A TMB complaint can trigger more than a simple review. It creates a formal record that may follow your career. The Board relies on documentation, expert review and statutory standards under the Medical Practice Act.Gaps in your response or incomplete records may affect how the Board evaluates your conduct. Even minor issues can escalate if they suggest a pattern or lack of compliance.
When to consider legal guidance
Responding to a Board complaint involves strict deadlines and detailed documentation. You may need to interpret regulatory standards and present a clear defense.Working with counsel familiar with administrative and health care law can help you evaluate your position. An attorney can help you prepare responses, organize records and address potential risks at each stage. This approach may improve how your case is presented and understood.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Healthcare fraud: 3 practices that raise red flags]]>https://www.rivasgoldstein.com/?p=509162026-03-23T14:34:53Z2026-03-24T14:34:03ZBilling for services not provided
Billing for services that never happened creates immediate legal exposure. If you submit a claim for a visit a patient missed, a procedure you did not perform or a test no one ordered, you create a paper trail that does not match reality. Insurers routinely compare claims data against patient records to find those gaps. Even a few unsupported claims can trigger an audit. Regulators refer to this as “phantom billing” and treat it as fraud.
Inflating or misrepresenting billing codes
Upcoding happens when you bill for a more expensive or complex service than you actually provided. If your claims regularly show higher-level procedures or longer visits without clear support in your notes, reviewers will start asking whether your documentation truly backs up what you billed. One mistake may look like a coding error, but when the same gap between your notes and your billing shows up again and again, it stops looking accidental.
Engaging in improper referral or kickback arrangements
Improper referral arrangements arise when you offer or receive something of value in exchange for patient referrals. Federal law prohibits financial incentives that influence where a patient receives care. Investigators look closely at compensation models that track referral volume instead of legitimate services. If money or benefits flow in a way that depends on how many patients someone sends you, enforcement agencies may view that structure as unlawful.
Address concerns before regulators do
You do not have to wait for a subpoena to take these warning signs seriously. If you notice billing, coding or referral practices that raise concerns, review them now and correct the issue before a routine audit turns into a formal investigation. If you are unsure about your legal risk, get guidance from a health care lawyer. A proactive step today can protect your practice tomorrow.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[What happens if your pharmacy receives a DEA subpoena?]]>https://www.rivasgoldstein.com/?p=509232026-03-23T14:02:34Z2026-03-23T14:02:34ZRecognizing the scope and authority
Unlike a criminal search warrant, which requires a finding of probable cause by a judge, a DEA subpoena is issued directly by a DEA special agent-in-charge or an assistant special agent-in-charge. This type of administrative demand usually seeks several kinds of records, including:
Controlled substance dispensing logs and prescription records
Inventory records and ordering history
Financial records connected to controlled substance sales
The DEA often asks for records that cover several years and expects the pharmacy to produce them together. A subpoena does not enforce itself. If your pharmacy challenges the request or its scope, the DEA must ask a federal court for an order that requires production.
Avoiding costly missteps that you might encounter
A careful review of the subpoena provides a good starting point after you receive it. This can help you understand the scope of the request and organize your response.
Another factor to consider is to immediately preserve every document that falls within the request. Federal obstruction laws impose serious penalties if someone destroys, alters or hides records after a government inquiry begins.
You might also feel pressured to offer voluntary statements or extra records beyond what the subpoena requests, believing full cooperation will help their position. In practice, it can expand the inquiry and create new issues.
Evaluating a careful and informed response
One of the most important strategic questions is whether your pharmacy is the target of the investigation or simply a third-party source of records. A subpoena seeking your dispensing logs for a specific prescriber, for example, may have nothing to do with your own practices. That distinction shapes everything from the type of counsel you need to how you frame your response.
Because dispensing records contain sensitive health information, the Health Insurance Portability and Accountability Act (HIPAA) minimum necessary standard under the privacy rule adds another layer of protection. Federal privacy rules may limit what you can disclose beyond what the DEA has asked for. An attorney can help assess whether the subpoena is overbroad and, if warranted, negotiate its scope with the agency or file a motion to quash.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Can mental health concerns jeopardize your nursing license?]]>https://www.rivasgoldstein.com/?p=509172026-03-04T06:55:32Z2026-03-04T06:55:32ZThe empathy and resilience required for nursing can often lead to burnout, depression or secondary trauma. While patients are encouraged to seek help, you may worry that addressing your own mental health will spark a fitness-to-practice investigation. Understanding the legal line between personal health and licensing concerns is the first step in protecting your career.
Not an automatic trigger
In Texas, the Board of Nursing (BON) does not discipline nurses simply for having a mental health diagnosis. The Board only intervenes when a condition, whether physical or mental, results in "intemperate use" of drugs or alcohol or a "lack of fitness" that endangers patients. Investigations typically stem from:
Workplace incidents that raise safety concerns
Employer reports regarding your performance
Self-disclosures on license renewal forms
Specific incidents or "near misses" in a clinical setting
The BON’s primary mandate is public protection. They look for evidence that a condition is unregulated or unmanaged, rather than the mere existence of the condition itself.
Compliance with treatment: Are you following a prescribed plan from a Texas-licensed provider?
Professional monitoring: Participation (or lack thereof) in peer assistance programs.
The "Yellow Light" vs. "Red Light" approach: Whether the condition is currently "controlled" by medication or therapy.
Forensic psychological evaluations: The BON often requires an evaluation by a Board-approved evaluator rather than your own personal doctor.
Workplace support: Letters from supervisors confirming you are practicing safely and meeting the "Standard of Care."
Nurses who manage their conditions transparently and maintain strong records usually see more favorable outcomes. In contrast, those who hide issues or refuse help face greater risks to their credentials.
Protecting your license and your rights
In Texas, practicing while impaired by mental illness or chemical dependency violates the Nursing Practice Act. Still, the Texas Peer Assistance Program for Nurses (TPAPN) provides a non-disciplinary, confidential path to recovery. This program allows you to maintain your license and continue working under specific monitoring, though it requires a rigorous, multi-year commitment where any failure to comply leads to a formal BON referral and public discipline.
If the Board contacts you regarding an eligibility issue or a complaint, it is vital to avoid providing a written statement or signing a Proposed Agreed Order until you understand the long-term impact on your permanent record. While honesty is required, it is best to limit self-disclosure to what is legally necessary to avoid providing irrelevant medical history that exceeds the Board’s reach. With professional guidance, you can prove you are fit for duty while ensuring your private health matters remain as confidential as possible.
Attorney John Rivas is responsible for this communication.]]>On Behalf of Rivas Goldstein, LLP<![CDATA[Texas doctor sentenced to 10 years and millions in restitution for fraud]]>https://www.rivasgoldstein.com/?p=509112026-02-26T19:29:31Z2026-02-24T06:00:46ZIt is no secret that the government will aggressively pursue allegations of healthcare fraud. In a recent example, the government built a case against a physician and healthcare employee who allegedly targeted elderly and disabled patients as part of a healthcare fraud scheme that cost the government millions. Those in the medical field are wise to know the basics of this case so they can take steps to protect themselves from similar allegations.
How the government build their case
The prosecution built their case using evidence centered on unnecessary lab testing and prescriptions directed to specific companies in exchange for kickbacks, plus bribes disguised as “rent” paid to adult day care owners for access to vulnerable patients. In addition to healthcare fraud charges the government also pursued charges for identity theft for forged patient signatures on consent forms. When reviewing the evidence, the jury found the physician and employee guilty and the judge sentenced the physician to 120 months and the employee to 97 months imprisonment along with mandatory restitution payments of over $3 million.
How the fact pattern created criminal liability
Two key allegations that are common in these types of cases include the use of medical necessity as a way to increase volume of claims, not a clinical judgment and remuneration tied to referrals, including “rent” arrangements lacking fair market value support. These allegations along with the presence of forged patient signatures strengthened the prosecution's argument that the accused intended to defraud the government.
Practical steps to reduce exposure before an investigation
This case serves as a reminder of the need for physicians to maintain proper documentation, refer based on medical necessity and have measurable auditing practices in place that can withstand review in the event of an investigation. It is also wise for groups to regularly review contracts to help better ensure compliance with applicable regulations like the Anti-Kickback Statute. These steps can help to mitigate the risk of allegations of wrongdoing and provide the necessary documentation to build a defense in the event of an investigation. Attorney John Rivas is responsible for this communication]]>On Behalf of Rivas Goldstein, LLP<![CDATA[The core stages of the Texas medical board disciplinary process]]>https://www.rivasgoldstein.com/?p=508982026-02-20T19:54:06Z2026-02-20T19:54:06ZCritical components of the investigation
A TMB investigation is a formal administrative track governed by the Texas Medical Practice Act. Although the TMB may request a response within 28 days as a matter of internal policy, state law generally provides a 30-day statutory minimum to respond to a notice of allegations. This initial narrative is your most vital chance to resolve the matter early.
When a standard of care complaint is filed, the board review centers on these phases:
Expert review and quality assurance: Before a case moves to litigation, it undergoes a Quality Assurance review. A panel of board-certified physician experts evaluates whether your actions met the accepted standard of care. Many meritless cases are dismissed at this stage if the experts find no violation occurred.
The informal settlement conference: If the experts find a potential violation, you must attend this hearing. It is an opportunity to show compliance with the law. The board is generally required by the Texas Occupations Code to schedule this within 180 days, though they may extend this timeline with written notice.
The SOAH contested case hearing: If no settlement is reached, the case moves to the State Office of Administrative Hearings (SOAH). This is an independent state agency for those entering the administrative process. Unlike a traditional trial, an administrative law judge (ALJ) hears the evidence and issues a proposal for decision.
Your narrative and evidence at the review stage provide the essential clarity needed to seek a dismissal.
Securing your professional future
The legal paperwork and board deadlines for a TMB investigation lock in your professional record. Starting with a direct and knowledgeable legal strategy builds the foundation for a secure path forward.
This allows you to focus on your practice while ensuring your rights are protected during the administrative process. An experienced attorney can review the specifics of your case to help you prepare for board interactions.
Attorney John Rivas is responsible for this communication.]]>