We know that the vast majority of healthcare providers are honest and ethical professionals who entered the field of medicine, nursing, or other healthcare specialty because of their passion for public health, healing, and working toward positive health outcomes for the benefit of others.
But we also know that sometimes good people make mistakes, make poor decisions, or have lapses in judgment. It's also true that, unfortunately, there are individuals in the healthcare industry who intentionally exploit, mislead, and cause harm, whether financially or in caring for patients.
Protect Your Professional License at All Costs
Maybe you know someone to whom this has happened, possibly even a close colleague or friend at work. While it's normal and understandable to feel compassion for a coworker and want to rationalize what may or may not have happened, you should take care to protect your own professional reputation and, most importantly, your license.
Your Ethical Obligations as a Healthcare Provider
No workplace friendship is worth putting your license in jeopardy over, and as a healthcare provider, you also have an obligation to report misconduct or illegal activity related to patient care, privacy, record-keeping, billing, and so on. Remember the American Medical Association (AMA) Code of Medical Ethics. As a medical professional, you have agreed to report conduct that puts patients at risk, whether that means reporting incompetent or unethical care to your state licensing board, your hospital's peer review body, or other authorities.
If this is something you've been thinking about because of a situation a colleague is going through, you're right to feel concerned, and you would be wise to seek legal counsel if you feel you have involved yourself to a degree that could be perceived as you helping your coworker.
Know What's at Risk When You Help an Accused Colleague
This can be especially common for new physicians or nurses, for example. This is why it's important to become familiar with common missteps that could result in accusations of wrongdoing, such as exploiting the healthcare system for personal gain, like Medicare or Medicaid fraud and abuse.
Unethical or illegal behavior could fall under violating state law, federal law, or other entities' codes of conduct. Penalties for a healthcare provider committing these acts could include civil fines, criminal penalties, or loss of their medical license from their state medical board. Educate yourself to avoid going down with them.
Common Pitfalls: Violating Federal Fraud and Abuse Laws
You'll want to understand, as a solid starting point, the following federal fraud and abuse laws and how to avoid being caught up in any allegations of supporting a colleague in violating them.
- The False Claims Act (FCA)
- The Anti-Kickback Statute (AKS)
- The Physician Self-Referral Law (Stark law)
- The Exclusion Authorities
- The Civil Monetary Penalties Law (CMPL)
What kinds of behaviors could result in possible sanctions? Some common areas include:
- Coding and billing errors
- Billing the federal government for services beyond “reasonable and necessary services” (e.g., submitting claims to Medicare that go beyond this designation)
- Incomplete or untimely documentation
- Kickbacks, self-referrals, or improper inducements (e.g., routinely waiving copays or deductible amounts for a friend without documenting their financial need)
Running into trouble with any of these laws could land a healthcare provider in hot water with the Department of Justice, the Department of Health & Human Services Office of Inspector General (OIG), or the Centers for Medicare & Medicaid Services (CMS).
When It's Personal: Reporting a Friend is Difficult, But Necessary
Clearly, physicians have to tread carefully when it comes to relationships with fellow providers. However, healthcare professionals of all kinds are susceptible to similar scrutiny and obligated to act ethically and within the law.
Your involvement in supporting a colleague may be direct or of a more peripheral nature, like turning a blind eye to misconduct. For example, a nurse might have witnessed a colleague stealing medication and be afraid to report them for fear of retribution. Or, you might be aware of a colleague's addiction to Adderall, for example, and sympathize with their struggle. It can be emotionally gut-wrenching to think about reporting them or not covering for them if they have stolen a controlled substance. But not doing so could spell disaster for you and your career. Withholding information or misleading authorities looking into such violations could mean serious consequences for you.
You May Need to Take Immediate Action to Disentangle Yourself
If you are a medical doctor, nurse, or other healthcare practitioner at risk of being found to be colluding with or supporting a colleague accused of wrongdoing, you should take immediate steps to untangle yourself of any suspect relationships and are advised to seek legal counsel.
Legal counsel can advise you on the risks and benefits of possible next steps. One example is utilizing the Office of Inspector General (OIG) OIG Provider Self-Disclosure Protocol, intended to help you steer clear of being involved in an investigation. Or, if you have information about fraud or abuse against federal healthcare programs, you should report it to the OIG Fraud Hotline: 1-800-HHS-TIPS (1-800-447-8477). The Lento Law Firm can help you navigate this process.
The Lento Law Firm Can Protect Your License
The Professional License Defense Team at the Lento Law Firm understands how seriously you take your ethical responsibilities. If your friendship with or the support of a colleague facing license-threatening allegations may entangle you in the investigation, you need to take immediate steps to detach yourself from the situation.
We know the law, and we're experienced in representing medical professionals nationwide before state medical boards. To learn how we can help ensure you don't go down with a coworker engaged in unethical or illegal conduct, contact the Lento Law Firm Team today at 888.535.3686 or use our automated response form.