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Comprehensive New Rules Govern Reporting of Doctors, Health Care Providers

Comprehensive New Rules Govern Reporting of Doctors, Health Care Providers

Sweeping new regulations issued from the Maryland Department of Health and Mental Hygiene, have several key preliminary definitional terms that require a hospital or practice group to report an employee to the Maryland Board of Physicians in certain situations from which he or she may face discipline and never be able to get another job.

For example, a Maryland-based hospital or practice group must report an employee if confronted with the following three employment scenarios:

  1. A doctor, licensed and practice in Maryland, voluntary resigns from employment with a local hospital after he is accused of sexually harassing a fellow hospital employee, not a patient;
  2. An ultrasound technician is placed on administrative leave for 45 days for failing to take required training; patient care was not at issue; or
  3. A physician’s assistant resigns, in lieu of termination, after it is discovered that he miscoded procedures to increase his compensation and which had nothing to do with patient care.

The regulations have several key preliminary definitional terms. The first is “reporting entity,” which is defined to include a hospital or related institution, and an employer of an allied health provider. The second is an “allied health provider,” which is defined as all the professionals licensed by the Maryland Board of Physicians, including physicians, physician assistants, respiratory care practitioners, naturopathic doctors, radiologists, and sleep study and nuclear medicine technologists, to name a few.

Under the new regulations, a reporting entity must report to the Board of Physicians any change to the status of the health care provider whom the reporting entity employs, who has a contract with the reporting entity, or to whom the reporting entity has granted privileges. A “change” is an action taken by the reporting entity against a health care provider, such as terminating or failing to renew a health care provider’s staff privileges or employment or contract with the reporting entity, or terminating or refusing or failing to renew or to extend the term of the academic contract of an individual in a postgraduate training program.

A “change” also encompasses disciplinary action short of termination or revocation of privileges, including suspension, probation, or restriction of privileges or duties. Importantly, the regulations define a “change” broadly to include actions that could be taken to try to avoid a required reporting. For example, accepting an involuntary resignation, or requesting that a health care staffing entity cease furnishing the services of a specific health care provider, are covered changes.

In the case of a physician, a change also includes denying an application for staff privileges and, for a physician assistant, terminating his or her delegation agreement.

The regulations now are unequivocal that a reporting entity must report to the Board of Physicians any change to the health care provider that has been made, in whole or in part, because the health care provider:

  • abandoned a patient;
  • committed billing or coding fraud;
  • suffers from a physical, mental, or emotional condition or impairment that affects the health care provider’s ability to perform the individual’s medical or surgical duties;
  • repeatedly violated hospital bylaws, rules, policies, or procedures after warning, among other situations;
  • disrupted the workplace; or
  • committed unethical or unprofessional conduct.

Not a change

There are several actions that are not considered a “change” and do not trigger a reporting requirement. A voluntary leave of absence is not considered a change in status when taken by a health care provider who is in good standing with the Board of Physicians (not subject to any discipline, pending discipline, supervision or restrictions) for innocuous reasons such as maternity leave, family problems of a medical or other personal nature, sabbaticals and military deployment. However, a leave for medical problems that implicate a provider’s physical, mental, or emotional ability to provide competent care is considered a “change” that triggers mandatory reporting.

The regulations provide that administrative suspensions are not a “change” that requires reporting if such suspensions are 30 days or less cumulatively in a calendar year and solely as a result of a failure to acquire mandated vaccinations or complete retired training, for example.

Special provisions apply to physicians. The regulations state that an involuntary alteration in a physician’s practice is not reportable the change results solely from a Focused Professional Practice Evaluation or a focused review, among other reasons. However, an automatic disqualifier from a non-reporting, involuntary alteration is when it is caused or results from inappropriate sexual behavior, harassment, or any other unprofessional conduct in the workplace.

If you believe you have been subjected to a situation in which a hospital or practice group has treated you improperly, the attorneys at Lebau & Neuworth may be able to help. For more information, contact us at 888-456-2529 or lebauneuworth.com/contact-us.

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