Before reviewing the collateral consequences of obtaining a probationary license as a health care practitioner or professional, lets provide some prospective and a disclaimer. Probationary licenses are not a bad thing. For many individuals, given their personal, social, or professional background, it may be wholly unavoidable. And for those individuals, it is much better than getting the proverbial door slammed in their face at the time of application. However, our law firm does see cases where a more carefully handled application–or a more thorough and competently handled investigation–could have resulted in disciplinary measures–such as a probationary license–being avoided completely.
By the time our firm gets retained on such a case, dismissal of the Statement of Issues or Accusation is nearly impossible. This can be attributed to the time and effort the respective Board has already exhausted on the matter and their unwillingness to let that time and effort go without something in return. This is why settlement negotiations for most the medical field licensees we represent (e.g. doctors, nurses, physical therapist, etc.) will likely start and end with various levels of a probationary license. So, taking the risk at the onset of a health care license application or investigation is much like taking a squeeze on a tube of toothpaste. And if you don’t like what comes out of it, it is next to near impossible to get toothpaste back into the tube.
So, now you are stuck with some form of a probationary license. And while it is not all of that bad–and many licensees are thrilled with it as a result as it lets them to start or continue in their profession–there are some hidden consequences one must be aware.
Licensees in the medical field are rarely paid cash by their patients, but, rather, rely on payments being made by a patient’s medical insurance carrier (i.e. Medi-Cal, Medicare, Blue Cross, etc.), outside any applicable co-pay of course. Each respective medical insurance carrier is given an opportunity to determine who it wishes to work with. And that is not on an employer-by-employer basis. Rather, it is based upon the individual licensee providing the specific health care service.
For example, let us assume that a physician is employed by a hospital that accepts Medi-Cal, Blue Cross, Aetna and Health Net insurance plans. Prior to treating any patients, the physician must apply for and receive certification by the respective insurance carrier. Without the requisite certification(s), the physician cannot treat patients with that health insurance plan.
You may ask yourself, why does this matter? If I have a license, probationary or not, I can still treat any patient I need to. Wrong! The issue that arises is during the certification and re-certification process of licensees with the insurance carriers. Licensees enter an agreement or contract with the insurance carriers to provide services to their members. Often those agreements include clauses requiring the licensees practice and treatment to be unrestricted. Almost all of these insurance carriers claim that a probationary license equates to a restricted license. With that mindset and belief, the carriers deny certification and refuse to permit the licensee to treat its members. This can and usually does lead to employment issues as a requirement of employment includes the ability to treat the employer’s patient population. Failure to obtain the certification prohibits this.
So, one must keep this in the back of your mind before accepting a probationary license. This is critically important when one of the drivers of that decision appears to be in order to maintain your present employment relationship. If your employer sees insurance patients or government benefit reimbursement programs, then this is something that will likely come up.
There are some mechanisms to minimize the impact of the probationary license. For example, some carriers will not categorically terminate or deny participation if the the settlement agreement avoids admissions. Thus, ensure that the stipulated settlement agreement does not require you to admit the truthfulness of each allegation stated in the Accusation. Rather, you might be able to negotiate the inclusion of “soft admissions” with the Deputy Attorney General. “Soft admissions” is a way around admitting guilt and requires the licensee to admit that disciplinary action could be taken against his/her license if the Board proves the allegations at hearing. This may appear like a minor change but it could make all the difference when fighting with insurance carriers about credentialing.
At Simas & Associates, we are obsessed with preparing our clients for investigative interviews impacting their licenses. Although we have written two blog articles about this subject entitled Physicians Beware! Unforeseen Consequences of Meeting with Read more…