Jul 24, 2024
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Dealing with a licensing board disciplinary review can be overwhelming and potentially devastating for healthcare providers. One complaint can require a provider to fight for the professional license it took years to get. That’s why it’s critical to understand the process, be prepared, and know how a medical malpractice insurance policy could help. (Considering board review assistance is one of the top reasons Berxi hears from its customers, offering this protection has left our insureds feeling confident they made the right choice!)
In this article, we’ll explore what the licensing board review process entails, as well as potential board disciplinary actions. We’ll also explain how these reviews differ from peer reviews and malpractice claims. Most importantly, we’ll explain how you can help protect your license and the reputation you’ve worked so hard to build, especially if you’re going through an upcoming licensing board review.
State healthcare regulatory boards or professional licensing boards protect the public in a number of ways. One of these is by investigating and, if appropriate, disciplining licensed professionals whose actions are seen as violations of medical standards of care and competence, the state ethics code, or federal or state law.
The licensing board typically starts an investigation when it receives a complaint filed against a licensed provider. Though often from patients, complaints can come from just about anyone, patients, family members of patients, co-workers, disgruntled former significant others, or even employers.
According to the Federation of State Medical Boards, after receiving a complaint, the licensing board “has the power to investigate, hold hearings and impose discipline.” The discipline associated with a case is referred to the “action” and can include assessing fines, suspending a license, or, in extreme cases, revoking the license.
Healthcare disciplinary actions are not all that common, but they do occur. For example, in 2021, according to the National Council of State Boards of Nursing (NCSBN), there were 18,145 adverse actions against nursing licenses, which accounted for 1% of all nursing licenses.
Because the state licensing board is responsible for protecting the public, it must review all complaints when the competency of a healthcare professional is in question.
Licensing board reviews differ from malpractice claims in many ways, including:
Typically peer reviews and licensing board processes differ significantly. However, it’s important to note that when a peer review uncovers misconduct or ethical violations, the review committee may refer the matter to the state licensing board. Here are some of the biggest differentiators:
So now that you know what a licensing board disciplinary reviews are, let’s look at why they happen. Some of the more common reasons healthcare professionals face disciplinary action from a licensing board include:
The licensing board disciplinary process varies by state, specialty or license, and licensing board panel. Anyone facing this process should make sure they understand each step.
First, a complaint is filed with the state licensing board. Complaints can be anonymously filed by anyone concerned about a provider’s conduct, competence, or care. Usually, they’re filed by a patient, patient’s family member, co-worker, or employer, and yes, even an angry roommate or former significant other. In addition, a criminal investigation against a provider could also trigger a complaint.
Once the complaint is received, the licensing board reviews it to determine the following:
If the board decides that the complaint meets these qualifications, it will advance the case to an investigation. But if the case is found to lack merit, the board will file it away, with no further action.
If the complaint passes the initial screening, it then moves to the investigation phase to determine its validity.
During this stage, the licensing board assigns an investigator who requests information from the healthcare professional, the individual who filed the complaint, and any witnesses. The board may also require medical records or other documentation, such as a bill for services. Depending on the complaint and what’s involved, the investigation can take several months.
Based on the investigation, the board determines whether to close the case, hold a hearing, or conduct a settlement conference. If the allegations are extreme (e.g., criminal or fraud charges), the board may choose to file formal charges for disciplinary actions, which could mean the provider would be temporarily unable to work.
If the board rules in favor of the claimant, it may take several actions against the healthcare provider, including:
The licensing board is required to report its disciplinary actions to the National Practitioner Data Bank, and the results are entered into a public database. Fines are typically paid to the nursing board or to the regulatory agency that oversees licensing.
A significant value-add with high-quality medical malpractice insurance policy is that it should include “licensing board protection defense.” Having medical malpractice insurance that includes “licensing board protection defense” can be incredibly helpful if facing this stressful process. It’s important to know whether your current malpractice insurance policy includes this coverage. Employer-provided policies, in particular, often do not provide this benefit, but having your own policy would.
At Berxi, all our malpractice plans automatically come with coverage extensions to help with legal defense costs for licensing board reviews. This means you’d get your own attorney from a nationwide panel of experts to assist you as part of your policy coverage.
What’s more, when our clients contact us about a board action, a claims adjuster reaches out to them within one business day to provide support and walk them through the process. Once the claims adjuster determines the coverage is available, they will assign an attorney to assist with the board hearing and be that calming point of contact throughout the process.
Whether or not you have medical malpractice insurance to cover the costs of legal counsel, you have a right to legal representation during the board review process. You can consult with an attorney before speaking with investigators and have your attorney present when being questioned. Here are more ways an attorney can help during a board review:
With so much at stake in a board licensing review, it’s critical that you’re prepared in the event you should ever face one. Here are some steps you can take:
Practice thorough, daily note taking in all your work. Make sure your patient notes on examinations, diagnoses, treatments, finances, and other related matters are complete, accurate, and detailed. Also, do not alter or add to your notes. You may not want to bring your notes into the hearing since they would be open to review by both sides, but they can help with the preparation of your defense.
As soon as you learn that you’re part of a disciplinary case (usually via letter, email, or phone call), contact your insurance company. Your claims manager will need time to review the case, determine proper coverage, and find you an experienced attorney who can help you prepare.
If your insurance is offered through your employer, you may need to coordinate with your employer to manage the licensing board matter. Keep in mind that board reviews might not be covered under your employer’s policy.
Be truthful in all your interactions, interviews, and testimony regarding your case. Your attorney can help you prepare your story to ensure it’s accurate. You don’t want to provide information that can lead to further examination.
A disciplinary proceeding can be incredibly stressful and unnerving. It’s important to remain calm and focused on your case. There’s a process to follow, and the outcome should not be presumed. Remember that you have extensive support and guidance throughout the process.
Discretion and confidentiality are key. Reach out to only a small group of trusted people who will not share the case with others. Remember, if you speak with others directly involved with the case, their recollection of details may differ from yours, which can lead to more confusion.
Being the subject of a licensing board complaint can be extremely difficult and stressful, with the license and reputation you’ve worked so hard to earn at risk. Keep in mind that while board reviews feel frustrating — and often unmerited — the goal is to keep the general public safe. A few takeaways from this piece:
If you don’t have your own malpractice policy or you don’t have coverage for board actions, Berxi can help. With affordable coverage and a simple application, you can get the protection you need in no time. Get started today!
Image courtesy of istock.com/Charday Penn
Last updated on Jul 24, 2024.
Originally published on Sep 08, 2023.
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Gina Gallagher is an award-winning copywriter, published author, and motivational speaker with more than two decades experience of providing freelance writing services to leading companies.
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