Ohio Independent Providers (IPs) RNs and LPNs, ODJFS, and Ohio Nursing Board complaints: Holding your feet to the fire! Really?

If you are working as an IP in the State of Ohio, then I would suggest the following regardless of whether you are new to the field or you have worked as a IP for 10+years:

1. Network with other IPs in your area;

2. Develop a relationship with other IPs who you can discuss practice, billing, documentation, and other issues with as the issues arise;

3. You should have a CPA to assist you with your taxes, your legal business entity and other financial issues;

4. Watch your billing; Medicaid Fraud and theft convictions are increasing and the short-tem and long-term consequences aren't pretty; and

5. Retain an attorney to assist you with regulatory compliance, practice, and legal issues as the issues arise in your practice because the issues will arise.

I am seeing a number of cases involving IPs, both RN and LPN which involve the failure to have a regulatory compliance or risk management plan for their business. You are essentially a home care agency and directly billing the State for home care services is a legal minefield as a "solo" act. Home health agenicies have outside legal counsel and some of the large home health agencies have an attorney(s) on staff "in-house." As a IP-RN or IP-LPN, do you have an attorney on retainer to assist you with practice issues?

Also I really think Nurse IPs should have their own "group" to focus on the issues facing nurse IPs. By a group I don't mean a union. A professional association for Ohio Nurse IPs was attempted several years ago but there wasn't enough interest.

Oh and also: if you are being asked questions, receiving correspondence via certified mail, on a conference call with individuals from one or more State agencies in response to an incident, and being asked to submit records and documents for review: you are under investigation, pumpkin. My nephew calls me pumpkin still at times and I have lost 20 pounds this summer. The next 10 pounds is going to be tough! I am combining water aerobics with my daily walks now.

Also as an IP if you are being investigated for an incident by Carestar and ODJFS stop rationalizing and minimizing the conduct in question.

"My husband said this is silly." Attorney response: Really!

"I can't believe they are so concerned about just paperwork." Attorney response: Really?

"I may have overbilled but I earned that money." Attorney response: Really?

"What's the big deal with boundaries? The patient got the care needed." Attorney response: Really.

Retain an attorney to assist you initially. I am seeing a number of the cases where IP-RNs and IP-LPNs represent themselves in an ODJFS hearing and then don't contact an attorney until they receive a Notice of Opportunity for a Hearing from the Ohio Board of Nursing based on the termination of their provider number.

If you didn't know this then let me tell you: an adverse action taken by ODJFS is reported to the Ohio Board of Nursing because you are licensed to practice nursing by the Board. This then starts another investigation by the Ohio Board of Nursing.

This is why its extremely important for IP-RNs and IP-LPNs to:

1. Have an individual professional liability insurance with a license defense benefit that will cover attorneys fees and costs in ODJFS and Ohio Nursing Board complaints, investigations, and adjudications; and

2. Contact an attorney initially whenever an incident is reported.

Its your nursing license, its your provider number, its your business, and YOU as a professional should manage the risk. Taking a wait and see approach isn't managing the risk.

Comments

[LaTonia]

Thanks, Marc. Its frustrating. Its one thing not to know the law, rules, regs, and standards for your own invidiual nursing practice but when you combine these with the running a business and billing and providing healthcare services to the public, you are asking for double trouble. If you own and operate a nurse-owned business you must have a plan for regulatory compliance and risk management. This applies to IP-RNs, IP-LPNs, APRNs in private practice, etc. Work with a practice consultant or retain an attorney who specializes in nursing practice issues.

[Marc]

Latonia,

I can't believe these folks would consider working this way without having an attorney (or some sort of practice consultant at the very least, with experience in the field) on retainer. This is a business expense that should not be shorted in any way and should be treated as any other important business expense, like malpractice insurance or medical supplies.

When a nurse is practicing independently of an employer such as a hospital or agency, they are RUNNING A BUSINESS! I suspect you are seeing a bunch of nurse that thought they could "just wing it" and do just fine. But as the old saw goes - a failure to plan is planning for failure.

And to top it off, if they become an excluded provider with regards to medicare, they may well become unemployable (state board investigations are having the same effect in many cases now with the economy in the current economic doldrums) if they try to start working for an employer.

I think you have it right when you give these folks that answer to some of those ridiculous statements . . . Really?!?!?

Marc Meyer