A recent Texas Medical Board order suspending a Houston physician shows the serious consequences that can result if a physician subject to an order fails to comply.

Board’s Suspension of Dr. Theresa Cachuela Rice

In September, 2011, the Board automatically suspended the license of Houston doctor Theresa Cachuela Rice, M.D., requiring Dr. Rice, 79, to immediately cease practicing medicine in Texas after Dr. Rice failed to complete Continuing Medical Education and to take and pass the Texas Medical Jurisprudence Exam as stipulated by a previous March 2010 Order.

In March 2010, the Board and Dr. Rice entered into an Agreed Order requiring Dr. Rice to: pass, within one year from the date of the entry of the Order, the Texas Medical Jurisprudence Examination within three attempts; complete 24 hours of CME within one year; and pay an administrative penalty of $1,500 within 60 days of the date of the entry of the Order.

The 2010 Order was based on the Board’s finding that Dr. Rice: failed to meet the standard of care; aided and abetted the practice of medicine by a person not licensed by the Board; and failed to supervise adequately the activities of those acting under her supervision.

In its 2010 decision, the Board considered as a mitigating circumstance that Dr. Rice was one of several doctors duped by a Nigerian businessman who had a history of fraudulent activity. At that time, the Board elected not to suspend Dr. Rice subject to her completion of continuing medical eduction (CME) and fulfillment of other terms.

The Board’s announcement of the suspension of Dr. Rice does not provide any information about the reasons or circumstances underlying the alleged failure by Dr. Rice to fulfill the terms of the Board’s order.  According to the announcement, however, Dr. Rice will have the opportunity to appeal her automatic suspension.

Physicians Should Take Seriously Board Charges & Orders

While most physicians that become subject to a disciplinary order of the Board generally comply, from time to time, some physicians do not.  Because of the potential severity of the consequences for failing to comply with a Board order, physicians facing discipline need to fully understand the charges leveled against them, the expectations of the Board regarding the past behavior of the physician, and the Board’s expectations about the physician’s action and future conduct as soon as possible after charges are first leveled to the Board.  While many physicians agreeing or subjected to discipline by the Board or another disciplinary body often do not fully agree with the discipline, most understand the need to comply with the order and adjust their behavior to ensure their ability to demonstration that compliance to the Board.

Frequently, physicians under disciplinary investigation by the Board may feel the charges leveled against them are unjustified or otherwise disagree with criticisms regarding the physician’s behavior.  When this is the case, before deciding how to respond to the charges in question, it is important that the physician carefully and objectively review the conduct underlying the charges with qualified counsel in light of board rules and other standards of care to assess the likelihood that the Board can be persuaded to agree with the physician’s perspective or if not, what other response the Board is likely to have to the conduct under review.  When making these evaluations, it is critical that the physician exercise caution to ensure the objectiveness of this analysis.

Whether negotiating a voluntary consent order or considering whether and how to discipline a physician following a hearing where the Board finds fault with the conduct under review, the Board’s perception about the culpability of the actions of the physician, the physician’s acceptance of the need for changes in conduct and the likelihood that the physician will make the required change and comply with the Board ordered corrective action and other Board rules going forward play heavily into the decision of what discipline is ordered. 

When it feels the inappropriateness of the conduct to be relatively clear, the Board is likely to view the persistence of a physician in contesting the charges as reflecting the physician’s failure to accept responsibility for his or her misconduct as well as an indicator that the physician is unlikely to comply with the Board’s expectations in the future.  For this reason legal counsel for a physician often might recommend that the physician consider seeking to negotiate a voluntary consent order with the Board when the legal counsel is concerned that the Board might find fault with the conduct of the physician.

While genuine contrition and a commitment to work to improve compliance going forward may help mitigate Board discipline exposures at the time expressed, a physician pursuing this strategy must be prepared to in fact comply with the orders of the Board and adjust his or her behavior accordingly.  As reflected by the Board’s action against Dr. Rice, the Board rarely is sympathetic or lenient when it determines that a physician fails to comply with a Board order.  Consequently, physicians entering into a voluntary consent order with the Board or subject to an order imposed by the Board should make every effort to understand and fully comply.  If legitimate circumstances beyond the control of the physician subsequently prevent or undermine the ability of the physician to comply with the order, the physician immediately should consult with counsel regarding the potential to modify the order or other actions that are required or advisable to mitigate the potential sanctions from the Board for failing to comply.

Physician Personal Misconduct Topic of Stamer’s 9/27 HCMS CME Program

While the Board’s announcement about the suspension of Dr. Rice does not indicate any facts or circumstances at this time surrounding her noncompliance, a review of published Board actions reveals that in many instances, physicians that incur follow up discipline for failing to comply with Board orders often are impacted by a physical or mental condition, substance abuse or other circumstance impairs the ability of the physician to appreciate the need to comply or his or her ability the conform behavior to the required expectation.

Cynthia Marcotte Stamer will discuss licensing board, peer review, tort and other exposures arising out of sexual, substance abuse, or other personal misconduct issues affecting physician and other health care providers in a program entitled “Sex, Drugs & Rock ‘n Role” for the Harris County Medical Society Central Branch on October 27, 2011.  To register or for other details, see here.

For More Information Or Assistance

If you need assistance conducting or reviewing or responding to a medical licensing board, peer review or other health care quality investigation or concern or with other health care related risk management, compliance, enforcement or management concerns, the author of this update, attorney Cynthia Marcotte Stamer, may be able to help. Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 24 years experience advising health industry clients about these and other matters. Her experience includes advising hospitals, nursing home, home health, rehabilitation and other health care providers and health industry clients to establish and administer compliance and risk management policies; prevent, conduct and investigate, and respond to peer review and other quality concerns;  and to respond to Board of Medicine, Department of Aging & Disability, Drug Enforcement Agency and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns.

A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions.

Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 

If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile here. For important information concerning this communication click here. If you do not wish to receive these updates in the future, send an e-mail with the word “Remove” in the Subject to here.

©2011 Cynthia Marcotte Stamer, P.C.  Limited non-exclusive license to republish granted to Solutions Law Press.  All other rights reserved.

The Department of Health & Human Services today (August 26, 2010) announced the adjusted Federal Medical Assistance Percentage Rates (FMAP rates) that will apply for purposes of determining Federal Matching Shares for Medicaid and Title IV-E Foster Care, and Adoption Assistance and Guardianship Assistance Programs for the Third Quarter of Fiscal Year 2010 under adjustments made in response to about Section 5001 of the American Recovery and Reinvestment Act of 2009 (Pub. L. 111-5).

The FMAP is used to determine the amount of Federal matching for specified State expenditures for assistance payments under programs under Social Security Act (the Act) Sections 1905(b) and 1101(a)(8)(B).

In response to the economic downturn, Section 5001 of the ARRA provided for temporary increases in the FMAP rates to provide fiscal relief to States and to protect and maintain State Medicaid and certain other assistance programs in during a ARRA-designated recession adjustment period that runs from October 1, 2008 to December 31,  2010.  The CMS notice published sets forth adjusted FMAP rate for the third quarter of Fiscal Year 2010 under this provision.  These listed adjusted percentages apply to the third quarter of FY10, which ran from April 1, 2010 through June 30, 2010.  The rate adjustments set forth in the notice do not take into account changes, if any, that might be required as a result of Public Law 111-226, which the notice indicates will be addressed in future FMAP notices.

To review the rates and for details about how they were determined, see here

For More Information or Assistance

If you need assistance with these or other health industry regulatory, reimbursement or other operational or compliance concerns, please contact the author of this update, attorney Cynthia Marcotte Stamer.  Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients with licensure, contracting, reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. Ms. Stamer also regularly publishes and conducts training on these and other compliance, management and operations matters.  You can contact Ms. Stamer to inquire about engaging her services or for information about training or other resources that she provides at (469) 767-8872 or via e-mail here.  To get more information about Ms. Stamer and her health industry experience, see here.  

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

• CMS Publishes Corrections To Proposed 2011 Physician Fee Schedule Rules
• Medicare Changing How It Pays For Outpatient Dialysis
• Rite Aid Agrees to Pay $1 Million to Settle HIPAA Privacy Case As OCR Moves To Tighten Privacy Rules
• HHS Invites Input On Medicaid Changes To Promote Children’s Health Quality
• New Affordable Care Act Mandated High Risk Pre-Existing Condition Insurance Pool Program Regulations Set Program Rules, Prohibit Plan Dumping of High Risk Members
• 2010 Health Plan Update: Learn What You Must Do Now To Meet Key 2010/2011 Affordable Care Act & Other Federal Health Plan Deadlines
• CMS Rule Clarifies When Outpatient Services Subject to 3-Day Rule & Finalizes FY 2011 Inpatient Payment Rates
• CMS Proposes Changes To Civil Monetary Penalty Rules For Nursing Homes
• Office of Civil Rights Proposes Changes To HIPAA Privacy, Security & Civil Sanctions Rules
• CMS Proposes Rules To Implement Affordable Care Act Required Expansion Of Medicare Preventive Services And Other 2011 Reimbursement Changes
• NCPDP SCRIPT 10.6 Approved As Medicare Part D/Advantage E-Prescribing Option
• Proposed Medicare Rules Will Require Hospitals Honor Patient Visitation Preferences
• IRS Invites Input On Application of New Tax Exemption Requirements For Hospital Organizations Added By Affordable Care Act
• OIG Touts Expanding Health Care Fraud Enforcement Success & Launches New Health Care Fraud Hotline
• HHS Invites Input on Proposed Strategic Framework on Multiple Chronic Conditions
• New Affordable Care Act Health Plan Appeals Regulations Require Health Plan Updates
• Blockbuster & Health Delivery Disability Discrimination Settlements Highlight Need For Tightened Disability Discrimination Risk Management
• Pennsylvania Nurses Vote For Union In NLRB Election Highlights Rising Union Organizing Activity In Health Care Industry
• WellPoint To Ban Coverage Rescissions Before Affordable Care Act Fall 2010 Deadline
• DEA/DOJ Release Interim Final E-Prescribing Rules
• Joint Commission Revises Medical Staff Bylaw Standard
• IRS To Allow Medical Resident FICA Refund Claims
• Rising Enforcement and Changing Rules Require Prompt Review & Update of Health Plan Privacy & Data Security Policies & Procedures
• Pfizer To Pay $2.3 Billion For Fraudulent Marketing In Largest DOJ Health Care Fraud Settlement
• Maximum Penalty For Patient Protection Act Confidentiality Breaches To Rise To $11,000

About Solutions Law Press

Solutions Law Press™ provides health industry and other risk management, legal compliance, management effectiveness and other resources, training and education on human resources, employee benefits, compensation, data security and privacy, health care, insurance, and other key compliance, risk management, internal controls and other key operational concerns. If you find this of interest, you also be interested reviewing some of our other Solutions Law Press resources available for review here. If you or someone else you know would like to receive future updates and notices about other upcoming Solutions Law Press events, please be sure that we have your current contact information – including your preferred e-mail- by creating or updating your profile at here. For important information concerning this communication click here.

©2010 Solutions Law Press. All rights reserved.

President Obama on June 25, 2010 signed the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010 (H.R. 3962), which grants physicians temporary relief from cuts to Medicare reimbursements to physicians until November 30, 2010.

The provisions of H.R. 3962 delay a scheduled 21.3% cut to Medicare physician payments until Nov. 30, 2010.

Coincident with his signature of H.R. 3962, President Obama also directed the Secretary of Health and Human Services to take steps to minimize any disruption to, or administrative burden on, Medicare physicians and other affected providers and to minimize any disruption in the ability of Medicare beneficiaries to access necessary services by:

• Directing the Medicare claims administration contractors to immediately implement the legislative update to the physician fee schedule conversion factor;
• Providing all appropriate resources for the Medicare claims administration contractors to ensure the update is implemented as rapidly as possible;
• Directing the Medicare claims administration contractors to automatically reprocess, to the extent feasible, any claims reflecting the 21.3 percent fee schedule reduction, in order to relieve the administrative burden on physician practices;
• Take all necessary steps, to the extent permitted by law, to protect Medicare beneficiaries from any disruption to their access to services that may be occasioned by the reprocessing of claims; and
• Reopen the 2010 Annual Participation Enrollment Program through July 16, 2010, to allow physicians and other affected providers an additional opportunity to participate in Medicare.

While H.R. 3962 provides welcome relief for physicians, the 6-month period of the delay means physicians will again face Medicare reimbursement cutbacks later this year unless Congress can be persuaded to enact a more permanent extension.  The Medical Group Management Association and other physician organizations are continuing to urge physicians to encourage Congress to enact this more permanent relief.  See here.

The author of this update, attorney Cynthia Marcotte Stamer, has extensive experience advising and assisting health care providers and other health industry clients with reimbursement, compliance, public policy, regulatory, staffing, and other operations and risk management matters. You can get more information about her health industry experience here.   If you need assistance with these or other compliance concerns, wish to inquire about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 

Other Recent Developments

If you found this information of interest, you also may be interested in reviewing some of the following recent Updates available online by clicking on the article title:

• Proposed Medicare Rules Will Require Hospitals Honor Patient Visitation Preferences
• IRS Invites Input On Application of New Tax Exemption Requirements For Hospital Organizations Added By Affordable Care Act
• OIG Touts Expanding Health Care Fraud Enforcement Success & Launches New Health Care Fraud Hotline
• HHS Invites Input on Proposed Strategic Framework on Multiple Chronic Conditions
• New CBO Analysis Hikes Projected Affordable Health Care Act Cost by $115 Billion
• HHS Invites Input on Proposed Strategic Framework on Multiple Chronic Conditions
• New CBO Analysis Hikes Projected Affordable Health Care Act Cost by $115 Billion
•  Pennsylvania Nurses Vote For Union In NLRB Election Highlights Rising Union Organizing Activity In Health Care Industry
• NTHCPA Hosts May 11 Compliance Program on “Diversity & Nondiscrimination In Patient Care”
• WellPoint To Ban Coverage Rescissions Before Affordable Care Act Fall 2010 Deadline
• Veterans Health Administration Invites Public Comment on Information To Be Required To Make Online Copayment Payments
• CMS Proposes FY 2011 Acute Care & Long-Term Care Inpatient Policy & Payment Rate Changes
• Agencies Seek Public Input On New Insurer Premium Revenue Reporting Obligations Added By Patient Protection and Affordable Care Act
• DEA/DOJ Release Interim Final E-Prescribing Rules
• Joint Commission Revises Medical Staff Bylaw Standard
• IRS To Allow Medical Resident FICA Refund Claims
• Stamer Speaks To Chiefs of Staff About JCAHO Physician Performance Evaluation Requirements
• HIPAA Heats Up: HITECH Act Changes Take Effect & OCR Begins Posting Names, Other Details Of Unsecured PHI Breach Reports On Website
• HHS Delays 2010 HHS Federal Poverty Rate Update To March 1, 2010
• Rising Enforcement and Changing Rules Require Prompt Review & Update of Health Plan Privacy & Data Security Policies & Procedures
• Pfizer To Pay $2.3 Billion For Fraudulent Marketing In Largest DOJ Health Care Fraud Settlement
• Maximum Penalty For Patient Protection Act Confidentiality Breaches To Rise To $11,000
• OIG Special Fraud Alert Targets DME Telemarketing
• Federal HEAT & Other Federal Health Care Fraud Efforts Score More Than 15 Successes As OIG Claims $20.97 Billion Saved From Enforcement Activities In December
• HEAT Initiative Snares Health Fraud Related Guilty Pleas of Physical Therapist, Money Launderer and Patient Recruiter In Detroit
• Retaliation For Filing HIPAA Complaint Recognized As Basis For State Retaliatory Discharge Claim
• Quest Diagnostics Inc. To Pay $688,000 In Overtime Back Wages Settlement After Misclassifying Systems Employees As Exempt
• Homecare Workers Exempt From FLSA

For More Information

We hope that this information is useful to you.  If you need assistance evaluating or responding to the Health Care Reform Law or health care compliance, risk management, transactional, operational, reimbursement, or public policy concerns, please contact the author of this update, Cynthia Marcotte Stamer, at (469) 767-8872, cstamer@Solutionslawyer.net.

Vice President of the North Texas Health Care Compliance Professionals Association, Past Chair of the ABA Health Law Section Managed Care & Insurance Section and the former Board Compliance Chair of the National Kidney Foundation of North Texas, Ms. Stamer has more than 23 years experience advising health industry clients about these and other matters.  A popular lecturer and widely published author on health industry and human resources matters, Ms. Stamer continuously advises health industry clients about these and other related concerns.  Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, and other operations and risk management concerns.  Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  For additional information about Ms. Stamer, her experience, involvements, programs or publications, see here.  

You can review other recent health care and internal controls resources and additional information about the health industry and other experience of Ms. Stamer here.  If you or someone else you know would like to receive future updates about developments on these and other concerns, please be sure that we have your current contact information – including your preferred e-mail – by creating or updating your profile at here or e-mailing this information here. To unsubscribe, e-mail here.

©2010 Solutions Law Press.  All rights reserved.

October 13, 2009 Meeting Invitation/Reminder & Updated Meeting Agenda

North Texas Health Care Compliance Professional Association’s invites you to join us for our October 13, 2009 Meeting from 2:00 – 4:00 p.m. at the Texas Health Resources Pavilion. 

The first portion of the program will feature a discussion by Kristin Jenkins from DFW Hospital Council of:

• Modifications/upgrades in Group One’s Compliance Check processes;
• The ability to use the Data Initiative to pull RAC specific indicators and a dashboard in development for Compliance Officer use; and

 The second portion of the program will be a participatory Health Care Compliance Roundtable Discussion of Hot Topics moderated by the Erma E. Lee, JPS Health Network District Compliance Officer and NTPCA President. Topics to be discussed include:

• HIPAA Data Breach, Red Flag & Other Evolving Privacy & Data Security Obligations & Risks
• Office of Civil Rights Health Industry Disability & Other Civil Rights Enforcement
• Tax-Exemption Issues Including Proposed Form 990 and Exemption Reforms In Health Care Reform
• Health Care Fraud Enforcement
• Other Hot Developments

 NTHCPA invites interested persons to come catch up on these and other new developments and exchange thoughts and insights with other Health Care Compliance Professionals on Tuesday, October 13, 2009 from 2:00 – 4:00 p.m. in Classroom B of the Texas Health Resources Pavilion located at 612 E. Lamar Blvd., Arlington, TX. 

NTHCPA thanks Texas Health Resources for hosting this month’s meeting.  For additional information, please contact NTHCPA Vice-President Cynthia Marcotte Stamer at (214) 270-2402 or by e-mail at cstamer@solutionslawyer.net.

NTHCPA looks forward to seeing you there!

About the NTHCPA

NTHCPA exists to champion ethical practice and compliance standards and to provide the necessary resources for ethics and compliance Professionals and others in North Texas who share these principles.

The vision of NTHCPA is to be a pre-eminent compliance and ethics group promoting lasting success and integrity of organizations within North Texas.

To register or update your registration or to receive notice of future meetings, e-mail here .

This communication may be considered a marketing communication for certain purposes.  If you wish to update your e-mail for purposes of or would prefer not to receive future e-mail concerning meetings or other activities of the North Texas Healthcare Compliance Professionals Association or other marketing and promotional mailings from it, please send an email with the word “unsubscribe” in its subject heading to here.

September, 2009 has been designated National Prostate Cancer Awareness Month, 2009 under a Proclaimation issued by President Obama on August 31, 2009. 
TYpically highly treatable when detected early, prostate cancer affects both those stricken with the disease and their families, often occurring when they least expect it. 
You can read the Proclaimation http://edocket.access.gpo.gov/2009/E9-21502.htm.
Help celebrate by encouraging friends and families to seek appropriate testing.