When MSPs conduct criminal background checks on practitioners or search for them on the OIG’s List of Excluded Individuals/Entities, chances are the results will reveal an honest application. However, that doesn’t mean practitioners aren’t committing insurance fraud.
Case in point: Sushil Sheth, MD, cardiologist from Chicago who was recently found guilty of stealing $13 million from Medicare and 30 other insurance companies over a five year period. Law officials say Sheth held privileges at three hospitals where he obtained patient information that he used for false billing purposes.
Click here to read more about the case which highlights the importance of conducting background checks.
For a while now we’ve been following the story of Anne Mitchell, RN and Vicki Galle, RN who reported a physician to the Texas Medical Board. It seemed that the final chapter was written in February when Mitchell received a not guilty verdict from the jury. Galle’s case had been dropped earlier.
However, the latest detail of the case emerged this week with the announcement that the nurses will share a $750,000 payment from Winkler County, TX where the original charges were filed.
Take the poll below to see how your medical staff compairs to others.
Carey Ann Ryan, a nurse-midwife working in Iowa, recently agreed to pay a $1,000 fine to the state and enroll in an ethics education program in part because she did not tell a high risk patient that she did not have hospital admitting privileges, according to a July 22 article on DesMoinesRegister.com.
The patient in question eventually switched healthcare providers before her delivery and delivered in a hospital four weeks before her due date.
The case raises interesting questions about what information practitioners—hospital based or otherwise—should disclose to their patients.
Other issues that practitioners disclose to their patients may include if they accept Medicaid payments and if they have ties to pharmaceutical companies.
What information do your medical staff members disclose to patients? Share your experiences in the comment boxes below.
Physicians support the idea of reporting their impaired peers to the appropriate authorities, but won’t always report when faced with those situations in real life, according to a study in the Journal of the American Medical Association (JAMA).
Approximately 1,900 physicians participated in the study, “Physicians’ Perceptions, Preparedness for Reporting, and Experiences Related to Impaired and Incompetent Colleagues.”
The findings revealed that 64% of respondents, “agreed with the professional commitment to report physicians who are significantly impaired or otherwise incompetent to practice,” according to the study.
Additionally, 17% of respondents had direct, personal knowledge of an impaired practitioner, but only 67% of this group reported the impaired practitioner.
Which groups of physicians were mostly likely to report, according to the study? Those working in a hospital setting or a medical school were most likely to report.
The study found that physicians that don’t report do so because they think someone else will report the impaired practitioners.
The American Board of Internal Medicine (ABIM) claims that about 140 practitioners cheated on certification exams, according to a June 9 Wall Street Journal article. (http://online.wsj.com/article/SB10001424052748704256604575294712195930970.html). The practitioners allegedly purchased test questions from a test-prep company, which violates the ABIM’s test policy signed by test takers.
However, Christine Cassel, M.D., president and chief executive of the ABIM, is quick to point out that most test takers are honest and take the certification exam in good faith.
Click here to learn more about the case, and read “ABIM Sanctions Physicians for Ethical Violations,” on the ABIM’s website. (http://www.abim.org/news/ABIM-sanctions-physicians-for-ethical-violations.aspx)
It can be challenging for medical staffs to address issues that don’t have clear, black and white answers. For example, how would your medical staff respond to a practitioner who has excellent clinical skills but exhibits disruptive behavior? What if your medical staff had worked hard to recruit a practitioner, only to find out shortly thereafter that he had relapsed into chemical dependency? Obviously there are some clear regulatory standards that must be followed in these instances, but there are also ethical issues and concerns that each medical staff must address individually.
Take our poll below and find out how your organization compares with your peers’ organizations.
In light of Section 1921 updates, a recent newspaper article took a closer look at practitioner sanctions on the NPDB and found missing information. The article, produced by The Los Angeles Times and ProPublica, claims that states only sporadically report practitioners, such as nurses, pharmacists, psychologists and other licensed health professionals, and that states faced “no penalties,” for their actions
The article lists many examples of missing sanctions. “Judging from the federal numbers, no pharmacist has been disciplined in South Dakota or New Hampshire, and only one each in Alabama, Delaware, Ohio and Tennessee. But a search of those states’ websites showed hundreds of sanctions,” the article states.
After reading this report and considering your own experiences with the NPDB, how confident are you that the NPDB contains up to date information? Take our poll below and see how your opinion compares to your peers.
“It took the jury less than an hour to return a not guilty verdict this morning for Anne Mitchell, RN, defendant in the criminal trial that has come to be known as the ”Winkler County nurses’ trial. Mitchell faced a third-degree felony charge in Texas of ‘misuse of official information,’ for reporting a physician to the Texas Medical Board for what she believed was unsafe patient care….”
We first told you about the case of two nurses from West Texas who faced felony charges for reporting a physician to the state medical board last summer. The case has been working its way through the court system ever since then. Prosecutors dismissed the charges against Vicki Galle, RN (the felony indictment on her record will remain), but the trial against Anne Mitchell, RN, began on Monday, February 8.
Some of the complaints against the physician include evidence that he performed procedures without the necessary privileges and that he has a side business selling herbal medicines to patients, according to the news report.
How would your organization handle a practitioner who faced similar charges? What penalties does your medical staff impose on practitioners who practice outside the scope of their privileges?