Collateral Consequence of Disciplinary Actions NCAMSS Quarterly Meeting November 4, 2016 Thanks to Linda Waldorf and each of you I value my membership and am grateful you would have me Please interrupt with questions Talking about the effect of action against one credential on other credentials Follows on and updates my Synergy article, p. 10, May/June 2015 James A. Wilson, Attorney at Law

Why Is This Important? In the past, it was relatively simple for a physician disciplined in one location to move and avoid consequences Some infamous examples exist of patient safety compromises from failure to prevent such “geographical solutions” to their disciplinary problems – Blind Eye, James B. Stewart Various laws, rules, and practices evolved to make it easy to ask against physicians disciplined remotely Michael Swango Authority for reciprocal discipline James A. Wilson, Attorney at Law

Why Is This Important? Tools for addressing remote discipline increasingly are being applied automatically Could adversely affect members of your staff Could affect the willingness of your staff members to accept peer review actions Decreasingly covered by insurance James A. Wilson, Attorney at Law

Privileges Failure to maintain a current unrestricted license Failure to maintain a DEA registration Failure to maintain board certification Failure to maintain provider numbers Failure to maintain malpractice insurance Conviction of a crime Automatic relinquishment Actions by other hospitals Lesser actions by licensing boards James A. Wilson, Attorney at Law

Employment Failure to maintain a current unrestricted license Failure to maintain a DEA registration Failure to maintain hospital privileges Failure to maintain board certification Failure to maintain provider numbers Failure to maintain malpractice insurance Conviction of a crime Typical employment contract provisions Medical staff members increasingly someone’s employee, often the institution’s These are in addition to offenses (unprofessional conduct, substances, absences) James A. Wilson, Attorney at Law

Concerns if Practice is Interrupted Continuity of Care Winding down Pending prescriptions Tail Insurance Work While Uncredentialed Medical Board’s guidance on closing practice Pharmacy Board’s guidance of pending prescriptions James A. Wilson, Attorney at Law

Other State Licensing Boards Action by one licensing board is grounds for action by all others Several states act against inactive licenses Many states have self-reporting requirements James A. Wilson, Attorney at Law

Drug Enforcement Administration Can take their own actions Usually act only in cases involving controlled substances or loss of license James A. Wilson, Attorney at Law

Governmental Payers Can act based on other discipline Payer actions License actions Accreditation actions Self-reporting requirements Consequences can be severe Retroactive actions (payback) Prospective enrollment bars James A. Wilson, Attorney at Law

Private Payers Can act based on other discipline Some are rigid; most are flexible Self-reporting requirements Done with financial misconduct Confidentiality of patient information Don’t look at patient records James A. Wilson, Attorney at Law

Board Certification Most require full and unrestricted licenses, although each defines that differently Some permit MOC activities while not certified This law directly touches what you do Two main components Hearings Data Bank James A. Wilson, Attorney at Law

Malpractice Insurance Occasionally, insurance companies cancel or non-renew for disciplinary actions Except VA, HIS, and Shriners Requires physicians cover ER, which raises a whole set of issues Complicated James A. Wilson, Attorney at Law

Professional Corporations (and LLCs) State law renders one ineligible to own a professional practice upon loss of license James A. Wilson, Attorney at Law

James A. Wilson, Attorney at Law www.JamesAWilson.com What did I get myself into? Thanks. James A. Wilson, Attorney at Law