When a healthcare professional faces professional discipline the initial focus tends to be on getting through and beyond the proceeding. Healthcare professionals, however, should also be aware of the collateral consequences that may stem from a professional disciplinary action. We discuss some of those below.
Medicaid
A healthcare professional’s enrollment with state Medicaid programs may be impacted by an adverse professional licensing determination. For example, in New York, the Office of the Medicaid Inspector General (OMIG) works closely with the Office of Professional Medical Conduct (OPMC) and the Office of Professional Discipline (OPD), the state licensing boards for medical and dental professionals. The state licensing boards routinely advise OMIG of any actions against licensed professionals, from consent agreements to license suspensions or revocations, and OMIG then makes a determination whether to terminate or exclude providers.
If OMIG notifies a healthcare professional of its intent to exclude or terminate it is important to take steps to secure the provider’s appeal rights without delay.
Medicare
The domino effect from an adverse professional disciplinary decision does not stop with Medicaid. If a state Medicaid office takes action against a provider, under law, the agency must also notify the Centers for Medicare & Medicaid Services (CMS), which then makes its own determination whether to exclude the provider or impose other sanctions. As with Medicaid, providers should not delay in securing their appeal rights if notified of CMS’ intention to exclude or impose other sanctions.
Private Payers
The ripple effect of an adverse professional disciplinary action may be also be felt with private payers. Many managed care contracts and contracts with other third-party payers often specify that a provider will be terminated if a certain triggering event by a professional licensing board occurs. It is important to be aware of the obligations and reporting requirements imposed on providers by such contracts.
Hospital Privileges
It should not come as a surprise that an adverse professional discipline determination may effect a physician’s staff privileges at a hospital. Every situation is different and the outcome will depend on the particular level of professional discipline and the specific medical staff bylaws of a hospital.
Sister State Licenses
While states may differ in their definition of “professional misconduct,” it is not uncommon for an adverse determination from one professional licensing board to have a similar effect on a healthcare professional’s license in the sister state.
Healthcare professional may face other professional consequences depending on the different facts in each case. Providers should also know that similar collateral consequences could result from criminal and certain misdemeanor convictions.
As providers know, prevention is the best medicine. Becoming familiar with what constitutes professional misconduct under New York and New Jersey law is a step in that direction.
If you have any questions concerning professional misconduct, the impact of professional discipline on Medicare and Medicaid enrollment, or have other legal questions, please contact us here.