As a physician facing disciplinary action from the North Carolina Medical Board, there are steps you should begin taking promptly in order to minimize the consequences to the greatest extent possible. Depending on the severity and extent of the allegations, you could be facing sanctions up to and including revocation of your license – so you need to commit yourself to doing what is necessary to protect your practice.
While each case is unique, the following are all general steps physicians can take to begin preparing their defense when facing a grievance filed by the North Carolina Medical Board:
1. Make Sure You Understand the Allegations
The first step toward building an effective defense strategy is to understand the allegations against you. The notice you received should provide some insights, but you may need help from an attorney to gain a clear understanding of the severity of your present circumstances. The North Carolina Medical Board pursues cases for issues ranging from misrepresentations on license applications to criminal healthcare fraud, and the nature of your case will determine what you need to do to protect yourself.
2. Start Gathering Evidence
Once you know what the case is about, then you can start gathering evidence to aid in your defense. This could include academic records, patient records, billing records or any of a number of other types of documentation. You need to be careful about whose help you solicit during this process, and the best thing you can do is to seek guidance from your attorney.
3. Advise Your Staff to Avoid Mistakes that Could Hinder Your Defense
While you are facing disciplinary action, it is important that you and your staff avoid making mistakes that could jeopardize your defense. This takes on heightened importance if there is a possibility that the allegations involved could also lead to criminal charges. Any ongoing improprieties relating to the grievance should be addressed promptly, and your staff must avoid disposing of emails, records and other evidence that may be relevant to the case.
4. Understand the Possible Consequences of an Unfavorable Resolution
In disciplinary proceedings, the North Carolina Medical Board’s authority ranges from taking no adverse action to annulling or revoking the physician’s license to practice medicine in the state. Similar to understanding the allegations against you, understanding the potential consequences will be critical to constructing your defense. Can you avoid sanctions altogether? Or, should your defense strategy focus on minimizing the consequences of an adverse decision? These are crucial questions that require you to make informed decisions as soon as possible.
5. Hire an Experienced Professional License Defense Attorney
You are entitled to legal representation during your disciplinary proceeding; and, with your professional reputation (and potentially your license) at stake, you cannot afford to try to defend your case on your own. At Cheshire Parker Schneider & Bryan, PLLC, the attorneys in our professional ethics and licensing defense section represent physicians in Raleigh and statewide; and, if necessary, we can take action quickly to help you protect your practice.
Speak with a Professional License Defense Attorney about Your North Carolina Medical Board Grievance
If you are facing a grievance from the North Carolina Medical Board and would like to speak with an attorney about your case, contact Cheshire Parker Schneider & Bryan, PLLC to schedule a confidential initial consultation. You have questions. We have answers. Call (919) 833-3114 or request an appointment online today.
Following the Department of Justice’s national $900 million Medicare fraud takedown earlier this year, the Department of Justice, the Medicare Fraud Strike Force and other federal law enforcement authorities are continuing to aggressively pursue cases of suspected Medicare fraud. Medical providers and others in the healthcare industry throughout North Carolina are increasingly at risk for becoming targets in federal investigations, with civil and criminal prosecutions having the potential to lead to huge financial liabilities, loss of eligibility for Medicare reimbursement and even time behind bars.
But, what exactly is Medicare fraud? More importantly, what can practitioners in North Carolina do to help protect themselves from facing federal charges?
Common Allegations in Medicare Fraud Investigations
“Medicare fraud” is a broad term that encompasses violations of a number of different federal statutes. Some of the most common examples of Medicare fraud allegations include:
- Billing for Medically-Unnecessary Supplies or Services – Physicians will often face Medicare fraud charges based upon allegations of billing Medicare for services or medical supplies that were not medically necessary.
- Billing for Supplies or Services Not Provided – “Phantom billing” is the practice of seeking Medicare reimbursement for supplies or services that were never actually provided to a patient.
- Falsifying Patient Records – Submitting falsified patient records in connection with a reimbursement claim is another form of Medicare fraud.
- Making Prohibited Referrals – Under the Stark Law, physicians are prohibited from making certain referrals to companies with which they have a financial relationship. Stark Law violations are commonly charged as a form of Medicare fraud.
- Offering or Accepting Illegal Kickbacks – The federal Anti-Kickback Statute makes it illegal for physicians, pharmaceutical companies and others to make certain payments and provide other forms of compensation in exchange for recommendations or referrals.
- Unbundling Services – Under Medicare regulations, certain types of services must be billed at reduced, “bundled” rates. Unbundling services in order to claim higher reimbursement rates is a common form of Medicare fraud.
- Upcoding – Billing Medicare at a higher rate than is called for by the services performed or equipment supplied is a form of fraud known as “upcoding.”
The list goes on and on, and with the enormous complexity of the Medicare regulatory structure and billing system, it is not uncommon for physicians and others to face allegations when they have no knowledge of impropriety. Lack of knowledge can be a key defense in many Medicare fraud investigations, and you will want to promptly discuss your defense options with an experienced attorney.
Protecting Yourself (and Your Practice) in a Medicare Fraud Investigation
If you are facing a Medicare fraud investigation in North Carolina, there are several steps you need to try to take right away. Your goal should be to prevent the investigation from leading to civil or criminal charges, and the best way to do this is to hire an attorney to intervene in the investigation as soon as possible. Your attorney will be able to:
- Make contact with the investigators and prosecutors assigned to your case
- Determine the specific allegations against you
- Determine whether the investigation is civil or criminal
- Help you avoid unnecessarily disclosing information
- Help you address any practices that may have triggered the investigation
- Build a comprehensive defense strategy focused on minimizing the consequences of the investigation
Contact the Raleigh Criminal Defense Attorneys at Cheshire Parker Schneider & Bryan, PLLC
If you would like to speak with an attorney about your Medicare fraud investigation in confidence, contact the Raleigh, NC law offices of Cheshire Parker Schneider & Bryan, PLLC. To schedule an appointment as soon as possible, call (919) 833-3114 or contact us online today.