Liles Parker PLLC
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Washington, DC | Houston, TX
San Antonio, TX | Baton Rouge, LA

We Defend Healthcare Providers Nationwide in Audits & Investigations

Texas Medical Board Complaints are Serious Business!

Texas Medical Board Complaints are Serious Business

(September 20, 2013):   Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare’s requirements and those of private payors.  While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen.  Notably, Texas physicians are also obligated to ensure that their practices comply with each of the professional tenets of the Texas Medical Practice Act.  As many Texas physicians can attest, the Texas Medical Board will not hesitate to investigate and pursue disciplinary action.

I.  Texas Medical Board Complaints Resulted in 41 Disciplinary Actions in August 2013:

Late last month, the Texas Medical Board met from August 29-30, 2013 to consider a number of pending disciplinary cases that have been levied against Texas physicians.  By the end of the meeting, the Texas Medical Board had disciplined 41 licensed physicians and issued two cease and desist orders.  A review of these action can be quite helpful from a “compliance” standpoint.

II.  Overview of the Reasons for Disciplinary Action:

As the summary chart below reflects, a preponderance of the disciplinary actions taken by the Texas Medical Board involved “Quality of Care Issues” under the Texas Medical Practice Act.  Also prevalent among the disciplinary actions were “Non-Therapeutic Prescribing” and “Unprofessional Conduct.”  The ultimate disciplinary actions taken serve to highlight the various types of sanctions that the Texas Medical Board may choose to impose, depending in large part on a physician’s prior disciplinary record and the specific facts of each case.  The various sanctions imposed included:

Agreed Orders for Reprimands.

Peer Monitoring.

Continuing Medical Education (CME). 

Agreements to Refrain [from Certain Conduct]

Revocation of License

Suspension of License

The following chart provides a summary of the various disciplinary actions taken by Texas Medical Board during its August meeting.

 

 

Quality of Care

Unprofessional   Conduct

Other States Action

Physician’s Medical   or Mental Condition

Violation

of

Prior Order

Non-Therapeutic

Prescribing

Criminal

Behavior

Medical

Record

Keeping

Other

Total

Actions

11

52737213

Agreed

Order

9

32736213

Mediated

Agreed

Order

221

Public

Reprimand

2

1211

Monitoring

of Physician

2

Agreement

To Refrain

From Practice

4

213

1

CME

11

53511

1

Fine / Penalty ($)

62131

1

Suspension of

License

2112

Revocation

of License

51

1

As the chart shows, the Texas Medical Board revoked the license of physicians during the August meeting primarily based on the “Physician’s Medical or Mental Condition.”    The actions of the Texas Medical Board illustrate the role of patient and peer complaints in the investigative and disciplinary process. Each action announced in August, 2013 involved an Agreed Order or a Mediated Agreed Order.  The negotiation of an Agreed Order and the mediation of a Mediated Agreed Order may be best accomplished by a physician with the involvement of an attorney experienced in dealing with the State Medical Board and who understands the remedial and penalty processes typically invoked by a Board of this type.  Should you ever find yourself subject to an investigation by the Texas Medical Board or another State Medical Board, it is essential that you retain experienced health care legal counsel to represent your interests.

The health lawyers at Liles Parker, PLLC, regularly represent physicians and other licensed clinical professionals before State Medical Boards and licensing authorities around the country.  Should you have questions regarding a pending Texas Medical Board complaint, investigation or action, please give us a call for a free consultation.  1 (800) 475-1906.

HEAT Strike Force Update: Prosecutions in Texas Increased in March 2010

The Texas HEAT Strike Force is actively investigating Medicare fraud throughout the state.(April 3, 2010):  The Federal government is taking considerable steps to stop Medicare fraud and abuse. Notably, the number of publicly-disclosed HEAT Strike Force investigations and prosecutions in Texas significantly increased last month.  Two of the cases disclosed involved mental health professionals:

 

  • A Psychologist was convicted of health care fraud and money laundering, in connection with various claims fraudulently billed to Medicare.  Instances of improper conduct included billing for more than twenty-four hours of services in a single day; billing for services in a single day which amounted to more than double the normal business hours of the Psychologist’s practice; billing for services allegedly rendered during weekends, holidays, and times that the Psychologist was known to be out-of-town and away from the practice; and, submitting claims for services and evaluations not actually performed by the Psychologist, as required by law.
  • An unlicensed Behavioral Health Counselor was charged with Medicaid fraud for allegedly engaging in aggravated identity theft.  The defendant allegedly improperly acquired Medicaid beneficiaries’ information, including names, addresses and Medicaid numbers, then used the information to file false claims through a behavioral counseling service the defendant owned.  These behavioral counseling services were billed to Medicaid but allegedly not provided to the beneficiaries for which they were billed.

Since being established approximately a year ago, Texas’ HEAT Strike Force has significantly increased both investigations and prosecutions throughout the State.  Both enforcement efforts and the frequency of Medicare audits are anticipated to increase throughout 2010 and following years.  In addition to the increasing number of civil and criminal cases brought by the Texas HEAT Strike Force, the number of administrative overpayment cases is anticipated to grow as well.  It is essential that Texas providers continue their efforts to ensure that both business operations and billing practices fully comply with applicable statutory and regulatory requirements.

Liles Parker PLLC includes a number of attorneys with extensive former experience as Federal and / or State prosecutors.  Should your organization find itself under investigation, call us today for a complimentary consultation at: 1 (800) 475-1906.