Thursday, March 27, 2008

The BON may just be the beginning

A nurse is offered a voluntary surrender to settle the allegations against the nurse at the BON (or maybe the nurse is suspended or revoked, losing his/her license). The nurse agrees to the surrender because the BON tells the nurse that he/she can request the license back after one year and that the nurse either give up the license or have it taken away (more about this later). The nurse is able to work as a nurse aid or even a secretary for a hospital in order to bring in some money to his/her family, right? that type of work does not require a nursing license, so it is acceptable for the nurse to use his/her knowledge as long as the nurse does not overstep professional boundaries, correct?

Not so fast--there is another governmental agency ready to have a go at the nurse. Years ago, Congress gave power to the Office of Inspector General (OIG) to punish physicians who committed fraud in the Medicare program by excluding the physicians from the ability to get reimbursement. The power given to the OIG has increased so that it is no longer limited to only Medicare fraud. The OIG can exclude anyone, not just physicians, but also nurses, aides, administrative personnel, therapists etc. An exclusion means that the person cannot get Medicare reimbursement or work for any entity that receives Medicare reimbursement.

The OIG has two types of exclusions: 1) mandatory, meaning that there is no recourse to argue mitigating factors in order to decrease the amount of time excluded, and 2) permissive, which does allow the presentation of mitigating factors.

The type of actions leading to a Mandatory Exclusion according to the OIG's website are:
1. Conviction of program-related crimes Minimum exclusion period-5 years

2. Conviction relating to patient abuse or neglect Minimum exclusion period-5 years

3. Felony conviction relating to health care fraud Minimum exclusion period-5 years

4. Felony conviction relating to controlled substance Minimum exclusion period-5 years

5. Conviction of two mandatory exclusion offenses Minimum exclusion period-10 years

6. Conviction on 3 or more occasions of mandatory exclusion offences Permanent exclusion

7. Failure to enter an agreement to repay Health Education Assistance LoansMinimum period-until past due loan obligation is repaid

You are not protected by having pled nolo contendere or received deferred adjudication because the OIG's definition of conviction is as broad as most of the BON's.

There are many more permissive exclusions and here are some of those that may impact nurses:

1. Misdemeanor conviction relating to health care fraud. Minimum exclusion period -3 years.

2. Misdemeanor conviction relating to controlled substance Minimum exclusion period -3 years.

3. License revocation or suspension.Minimum exclusion period - the same or greater than the time period imposed by the state licensing authority

4. Default on health education loan or scholarship obligations Minimum exclusion period -until default has been cured or obligations have been resolved to Public Health Service's satisfaction

So, with the example above, the nurse voluntarily surrendering the nursing license would soon receive a letter from the OIG informing the nurse that he/she is being considered for exclusion from Medicare reimbursement. Since this is a permissive exclusion, the nurse can hire an attorney and attend a hearing to argue why the exclusion should not apply. So much for surrendering in order to reach a quick resolution.

It is an election year, which is the perfect time to advocate through your professional organizations that the broad exclusions need to be scaled back down to those actions that affect the Medicare program and not as another level of punishment for licensure actions or criminal incidents.

Now to revisit the other problem with voluntary surrender: Another problem with voluntary surrender is that in Texas(I do not know what other states do, but I do know that there are many states that do not accept the surrender of a license), nurses are told that they can reapply for their license in one year. So, the nurse submits a reinstatement packet and appears before the Board only to be told that not enough time has passed or that the nurse needs to meet certain requirements and then apply again in a year (requirements the nurse did not know he/she would need). I hear from many nurses that are distraught because they thought it would be an automatic reinstatement when they gave up their license a year previously.

Thursday, March 6, 2008

Office of the National Nurse

There is a movement to establish an Office of the National Nurse. I think this would help to elevate nursing in the public's eyes. According to the organization promoting this position:

An Office of the National Nurse would:
Establish symbolic national leadership by elevating and strengthening the Chief Nurse Officer of the USPHS to make this position visible to the nursing profession and the public.
Compliment the work of the US Surgeon General.
Promote involvement in the Medical Reserve Corps to improve the health and safety of the community.
Incorporate proven evidence-based public health education when promoting prevention.

There is much more information available at the blog