Being a licensed nursing home administrator (LNHA) is a rewarding profession, especially if you are passionate about helping the elderly. But the job comes with plenty of challenges, as well. Not only must you go through intensive education and training to be an LNHA, but nursing homes have come under heightened scrutiny in recent years and are often the subject of lawsuits claiming elder abuse and neglect. Even worse, allegations of misconduct, fraud, or jeopardizing residents can bring you under scrutiny with the state licensing board—and possibly even cost you your professional license.
Because licensing boards do not have an excessively high burden of proof, they have the latitude to invoke disciplinary action when they believe their standards have been violated. That means even a simple misunderstanding or mistake could put your entire career in jeopardy. What should you do if a complaint is made against you? How does the disciplinary process work? What steps can you take in order to preserve your license and your career?
Attorney Joseph D. Lento is an experienced professional license defense attorney who helps people in New Jersey, Pennsylvania, and New York who were at risk of losing their license. The Lento Law Firm has provided the following answers to important questions, so you know what to expect and how to proceed if your license as a nursing home administrator comes under scrutiny.
Which Agency in My State Conducts Investigations Into LHNA Violations?
Each state has its own licensing body that regulates the licensing of nursing home administrators, also administering disciplinary action when necessary. In New Jersey, you'll answer to the New Jersey Nursing Home Administrators Licensing Board. In Pennsylvania, it's the State Board of Examiners of Nursing Home Administrators. In New York, it's the NYS Department of Health Bureau of Credentialing. These boards will investigate any complaint against you or your practice in these states.
What Are the Possible Offenses That Could Lead To My Nursing Home Administrator License Being Revoked?
The following are the most common charges that could place your LHNA license in jeopardy:
- "Immediate Jeopardy" citations (IJ). When a compliance board investigates your nursing home facility and issues an IJ citation, it means your lack of compliance is putting residents in danger. Even if the situation is immediately corrected, the state licensing board is usually notified, and they may conduct an investigation into the role you played in IJ citation.
- Fraud. Common fraud examples include false billing of patients or insurance, falsifying patient diagnoses for purposes of insurance, false advertising, taking kickbacks, etc.
- Substance abuse/addiction. Allegations that you are addicted to drugs or alcohol can jeopardize your license, especially if you're accused of being under the influence at work.
- Sexual misconduct/improper relations. This broad category could include sexual advances against patients, employees, or colleagues, as well as unethical romances with patients.
- Criminal convictions. Having a criminal record won't automatically disqualify you from being an LHNA, but certain crimes of "moral turpitude" could trigger an investigation from the licensing board.
- Noncompliance with continuing education. LHNAs must often complete continuing education requirements to keep their licenses in good standing. Failing to do so could put your license in jeopardy.
Could the Licensing Board Invoke Lesser Penalties That Allow Me To Keep My Nursing Home Administrator's License?
Yes. Depending on the severity of your violation and how it's been handled, a disciplinary board may opt to impose lesser penalties than outright revocation. Examples may include:
- License suspension. Your license might be revoked for a set period of time, with the possibility of additional review.
- License restriction. The board may limit the activities or services that you provide because of state laws.
- Fines. A monetary penalty may be imposed by the board.
- Continuing education mandate. The board can order you to complete continuing education requirements as a condition for keeping your license.
- Reprimand. You may be issued a private or public warning by the board.
These other penalties may be better than having your license revoked completely, but they can still cause damage to your career since most disciplinary actions are a matter of public record. Residents and their families can easily look up your records to see if any disciplinary actions were taken against you. This could affect their willingness to trust you with patient care.
What Does the Disciplinary Process Look Like for LNHAs?
While specific disciplinary processes can vary from one state to the next, most licensing boards follow a procedure similar to the following when initiating disciplinary actions:
- Complaint. Most disciplinary proceedings begin with a formal complaint, whether against you personally or against the nursing home that you oversee. This complaint may be filed either by a patient, patient's family member, insurance company, colleague, or another practitioner.
- Board review/investigation. The board will investigate the complaint to determine its merit and credibility. The board will invite you to respond to the complaint. They may also interview witnesses, examine documents, etc., to ascertain the truth.
- Consent decree. If there is sufficient evidence to support the complaint, the board may negotiate a consent decree agreement with you as an alternative to launching a hearing. In the consent decree, you'll admit to wrongdoing and voluntarily submit to the board's recommended course of discipline. In some cases, this can be a good alternative to losing your license, or at least to keep the door open for reinstatement.
- Formal hearing. In the event that a consent order is not reached, or the charges are particularly egregious, the matter will be moved to a formal hearing. This hearing may take place in front of either the board or an Administrative Law Judge, depending on your state's rules.
- Final determination. The board will decide whether to impose disciplinary action and what that action might be--up to and including revoking or suspending your license.
At any point in the disciplinary process, the licensing board could decide that there isn't enough evidence to support the allegations and dismiss the complaint, even before there is a formal hearing. In many cases, having a professional license defense attorney can improve your chances of avoiding disciplinary action altogether.
An Investigator Has Arrived at My Nursing Home Unannounced. Am I Required To Let Them in and Answer Their Questions?
It depends on the situation. If the investigator is a compliance officer or surveyor inspecting the facility itself, then you have an obligation to accommodate them. However, if the investigator is there on behalf of the state licensing board to investigate you personally, you are not required to speak to them or let them enter. In that case, the investigator is actively looking for evidence against your LHNA license, and you do not have to incriminate yourself. Instead, politely ask for their credentials and contact information and tell them you will have your attorney contact them. Your attorney can take it from there.
What Is a Consent Decree? If One Is Offered, Should I Accept It?
Consent decrees are legally binding agreements between you, the state, and the licensing board. They allow you to agree on a set of prescribed sanctions in lieu of a formal hearing. A consent decree may be a good option if there is sufficient evidence to support disciplinary action, especially if it enables you to remain as a licensed nursing home administrator. At the same time, a consent decree is also an admission of guilt, and it will still appear in public records. If you can present evidence that could exonerate you, a consent decree may not be in your best interest. Never agree to a consent decree without seeking advice from an experienced professional license defense attorney.
Why Would I Need an Attorney if My LHNA License Is at Risk?
Nursing home administrators often don't understand the implications of a complaint against them. Sometimes they mistakenly believe they can convince the board to accept their position if they explain the facts correctly. The board exists to protect the public, not you. While you have the right to represent yourself before the licensing board without an attorney, experience shows that you're less likely to achieve a positive outcome if you try to do so alone. Any attempt to meet with the board informally can backfire because they are actively searching for evidence of wrongdoing.
In addition, your license is more than just an authorization to practice; it is a legal agreement between you and the state. That means any disciplinary action taken by the board against you is a legal action. For these reasons, it is a good idea to have a legal professional representing you before the board. You have a better chance of getting a fair result if you do this.
Does Hiring an Attorney Make Me Appear Guilty to the Licensing Board?
Absolutely not. The board doesn't expect you to be able to comprehend the legal or disciplinary processes involved in this investigation, and they are quite comfortable interacting with lawyers. The board does not consider you guilty if you hire an attorney. It is a sign that you are taking the matter seriously.
Do Minor Allegations Mean I Don't Need an Attorney?
Even if your complaint appears minor, it is still a good idea to retain an attorney for the best results. It is a mistake to assume that the board will not revoke your license for a minor offense. Furthermore, even minor complaints can cause serious damage to your professional reputation and career if they lead to disciplinary action. An attorney can often help you get minor complaints dismissed, so they don't become public records.
Can a Professional License Attorney Help Me Get My License Restated if It Has Already Been Revoked?
Yes—if reinstatement is a possibility, an attorney can definitely improve your chances for reinstatement. These requirements may be part of the reapplication process:
- Completing a reinstatement application, including a written explanation of why you are requesting it
- Paying reactivation and filing fees
- Sending a detailed job history for all jobs performed while your license was inactive
- Providing proof that you have met all stated requirements for reinstatement (e.g., continuing education)
- Submitting to any action plan prescribed by the state licensing board
A good professional license attorney will be able to coordinate your application and monitor its status, as well as negotiate with the board to get the best possible terms for your reinstatement.
What Will a Good Attorney Do To Help Me Keep My LHNA License?
An experienced license defense attorney can help improve your chances of keeping your license intact. An experienced attorney will do any/all of the following:
- Review the complaint with you, so you know what it is alleging and what is at stake
- Collaborate with you to develop an effective defense strategy to answer the complaint
- Assume the role of your official legal representative in all interactions with the board and/or an Administrative Law Judge
- Collect evidence and gather witnesses in your favor
- Negotiate with the board at numerous points to dismiss the complaint and/or for a more lenient outcome
- Defend you in a formal hearing
- Coordinate your reinstatement process if your license is already suspended or revoked
I Received Notification That I Am Being Investigated. At What Point Should I Contact an Attorney?
The sooner you act, the better. If you wait for the complaint to reach the formal hearing stage, you might find yourself at a disadvantage because the board won't generally convene such hearings unless they already believe there is enough evidence to discipline you. Hiring a professional license defense attorney early in the process creates more opportunities to negotiate a favorable resolution even before the matter goes to a hearing.
Your career prospects could be in jeopardy if your license as a nursing home administrator is being investigated. You have worked hard to get to where you are today and your career hinges on your license. Joseph D. Lento is an experienced attorney who has successfully represented many licensed professionals in New Jersey, Pennsylvania, and New York. He is familiar with how these licensing boards work and the disciplinary procedures. Do not let your career be ruined by a mistake or misunderstanding. Let us help you to save your license. Contact the Lento Law Firm at (888) 535-3686 today to discuss your case and your options.