Putting Your License on the Line: Understanding IDFPR s New Enforcement Actions. 62 nd Annual IHCA Convention & Trade Show September 12, 2012
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1 Putting Your License on the Line: Understanding IDFPR s New Enforcement Actions 62 nd Annual IHCA Convention & Trade Show September 12, 2012
2 The Illinois Department of Financial and Professional Regulation ( IDFPR ) Licenses and oversees nearly 1 million professionals who are required to be licensed in Illinois, including: Administrators Registered Nurses Licensed Practical Nurses Other Disciplines
3 The Illinois Department of Financial and Professional Regulation ( IDFPR ) The mission of the Division of Professional Regulation is to serve, safeguard and promote the health, safety and welfare of the public by ensuring that licensure qualifications and standards for professional practice are properly evaluated, applied and enforced.
4 IDFPR Disciplinary Process It begins with the determination of Substandard Quality of Care Substandard quality of care means one or more deficiencies related to participation requirements under , resident behavior and facility practices, , quality of life, or , quality of care, which constitute either immediate jeopardy to resident health or safety; a pattern of or widespread actual harm that is not immediate jeopardy; or a widespread potential for more than minimal harm, but less than immediate jeopardy, with no actual harm.
5 The Illinois Department of Financial and Professional Regulation ( IDFPR ) Professionals may be called before the IDFPR because: Bad Survey Immediate Jeopardy / Actual Harm Complaint made to IDFPR Mandatory Reporters (Federal regs require IDPH referrals) IDFPR s Internal Referral Process
6 IDFPR New focus on administrators and nurses Virtually all IJ s are now resulting in complaints against the administrator and in many cases the DON Managing the situation early is key The good news is that overall the Department and the Board understand the challenges providers face
7 IDFPR s Disciplinary Process Today Open an investigation Letters to the registered professional Request for information (sometimes) Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
8 What Do You Do When You Get a Letter? Don t freak out! Open investigation Request for information Take it seriously. Respond. Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
9 Request for Information In some circumstances, you may be asked to provide information before an interview is scheduled. Provide complete, clear, information. Address everything in the letter. Put your best foot forward. Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
10 Anatomy of an IDFPR Disciplinary Conference Introductions Reason for conference Questions and discussion about allegations Conference between attorney and board member Recommendation Consent offer (later) Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
11 Disciplinary Actions The range of disciplinary actions includes: Dismissal Administrative Warning Reprimand Probation License Suspension License Revocation Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
12 Options Dismissal case closed. Discipline imposed consent decree. Reject recommendation and proceed with formal complaint. Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
13 Anatomy of an IDFPR Case Complaint Answer Discovery Motions Formal hearing before ALJ Ongoing Settlement Discussions Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
14 Other Letters Skipping Steps CONSENT DECREE The IDFPR is trying to settle your case. Read carefully. Get help if you need it. FORMAL COMPLAINT Can begin with discovery Can sometimes be persuaded to hold a disciplinary conference Open investigation Request for information Disciplinary conference Consent agreement or complaint filed Discovery process Formal hearing
15 OIG Exclusion Section 1128(b)(4) of the Social Security Act (42 U.S.C. 1320a-7(b)(4) authorizes OIG to exclude any licensed professional from ALL federal health care programs. Includes - Medicare, Medicaid, TRICARE, Veterans Administration, etc. The OIG action arises when a professional license to practice is revoked, suspected, surrendered or otherwise lost.
16 Implications of OIG Exclusion The scope of the exclusion is broad Exclusion will persist at least as long as the license is disciplined For as long as the exclusion persists, the Federal Health Care program will make no payment for any services furnished, ordered or prescribed in any capacity by the individual with the disciplined license.
17 Implications of OIG Exclusion Also.... the person holding the disciplined license is prohibited from employment in any capacity to provide any items or services which are billed to a Federal Health Care Program.
18 IDFPR Want to know that you understand and appreciates the problem. Confirm that you did not cause problem. Confirm that you were aggressive in addressing the problem. Confirm you have a proactive attitude.
19 Common Themes Attorneys See In our experience, the most common issues that arise in IDFPR actions involve: Staff training Communication levels Failure to Investigate Proactive intervention Failure to report occurrences
20 Current Hot Issues for IDFPR Abuse Pain Management Falls Med Errors Lab Testing / Follow Up Blood Sugar Testing Bowel & Bladder Programs
21 QUESTIONS? Kathryn M. Stalmack Meredith A. Duncan Attorneys at Law Polsinelli Shughart, P.C. 161 North Clark Street, Suite 4200 Chicago, Illinois
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