Physicians Can Apply for Award Up To $105,000 for Serving In a Medically Underserved Area of California - Apply Dec. 1, 2016 to Feb. 28, 2017

Are you licensed in California and looking for a way to work in an underserved area and get student loan forgiveness? Physicians (allopathic or ostepopathic physician or surgeon) can apply for an award from the Steven M. Thompson Physician Corps Loan Repayment Program up to $105,000 in exchange for a service obligation in a medically underserved area of California. 

The link for the physican scholarship is: http://www.oshpd.ca.gov/HPEF/Programs/STLRP.html 

For more information go the website for this program (and for other health care provider scholarships) at State of California Office of Statewide Health Planning and Development, Health Professions Education Foundation.  There are also scholarships for Registered Nurses, LVNs, Dentists, Physician Assistants, Occupational Therapists, Pharmicists, SpeechTherapists, Certified Midwifes, Nurse Practitioners, and other health care providers and those deadlines vary. Review the website for deadline and application information.

This underserved area covers most of the state and is close to major urban areas. Visit the website link above for the map of the area covered.

Woman Excluded By OIG Indicted For Health Care Fraud for Failing to Notify Employer Home Health Agency of Her OIG Exclusion

In the past, individuals and entities excluded by the Office of Inspector General (OIG) have usually not been prosecuted for fraud. A recent Indictment shows that the government is going to be more aggressive in pursuing individuals excluded by OIG if they fail to notify their employers of their exclusion. 

If OIG excludes an individual or entity it means that no payment can be made by a federal health care benefit program (or state program that received federal funds) for services provided by that individual. 

The United States Attorney’s Office for the Middle District of Pennsylvania announced on March 31, 2016 that China Scott of Pennsylvania was indicted by a federal grand jury for Health Care Fraud for allegedly failing to notify her employer at Cool Waters, a home health care agency that she was an "excluded person" by OIG. Ms. Scott was excluded by OIG due to two previous health care fraud convictions.

According to the Indictment, between November 2015 and January 2016, Ms. Scott provided home health care services to a disabled individual through her employment at Cool Waters, a home health care agency. Since Ms. Waters is an excluded individual, the home health agency cannot receive payments from Medicare or Medicaid or other federally funded programs for her services and must return any payments. Ms. Scott allegedly failed to notify the agency that she is an excluded person.

Indictments and criminal informations are only allegations. All persons charged, including Ms. Scott, are presumed to be innocent unless and until found guilty in court. The investigation was conducted by the U.S. Department of Health and Human Services.

Attorney Commentary: This is a reminder to those in the health care business to run background checks on their employees, independent contractors, and employees of independent contractors who provide services. And simply because Medicare or Medi-Cal or Medicaid is not being directly billed, there are many government programs through HMO contracts, TriCare and other entities that it is very difficult to tell when a patient is Medicare or Medi-Cal (Medicaid) or TriCare.  

In addition, individuals should also check their background since we have seen cases where individuals were excluded and did not know for reasons such as student loan defaults. Finally, if excluded, individuals and entities need to remember that they must apply for reinstatement. It is not automatic. 

Posted by Tracy Green, Esq.

Frequently Asked Compliance Questions About DEA Registration

Compliance with federal and state laws by health care providers (physicians, physician assistants, and advanced nurse practitioners) is critical. One of the frequently asked questions we receive is whether DEA registrants have to complete a separate registration when they practice at different locations. There is no simple answer to this question but the answer depends on whether the various locations are in the same state and whether there is any direct dispensing of controlled substances at the various locations.

What is the DEA law? It's always best to start with the statute or regulation as that is your road map.  Title 21 C.F.R. § 1301.12(a) states, “A separate registration is required for each principal place of business or professional practice at one general physical location where controlled substances are manufactured, distributed, imported, exported, or dispensed by a person.” 

Question: But I am not "dispensing," I am prescribing so do I need a DEA registration at the other locations?

Answer: Yes since under DEA law  the term "dispense" includes prescribing.Title 21 U.S.C. § 802(10) defines the word “dispense” as including the prescribing of a controlled substance.

Question: I have three offices in California where I am prescribing controlled substances, do I need a separate DEA registration for each office?

Answer: If you are only prescribing and are not maintaining supplies of controlled substances, administering, or directly dispensing controlled substances in these other locations in the same state, then you do not need to register the other offices.  21 C.F.R. § 1301.12(b)(3).

If your other practices are dispesing or administering controlled substances (even Schedule III or IV), that office needs a separate DEA registration. For example, if you have a weight loss clinic that dispenses phentermine in three different locations in the state then you need DEA registrations at each office.  Another example is that if your office injects human growth hormone (Schedule III) at different locations, then you need DEA registrations at each location. Even if you have the phentermine or HGH shipped to only one office and then have it transported to the other offices, you need DEA registration at each office.

Question: If I work locum tenens in other states do I need a separate DEA registration in that state?

Answer: Yes. You will need to obtain a separate DEA registration in each state where they plan to administer, dispense, or prescribe controlled substances.

Question: If am working solely in a hospital/clinic setting, can I may use the hospital’s DEA registration instead of registering independently with DEA if the hospital agrees?

Answer: Yes this is allowed under 21 C.F.R. § 1301.22(c).

Importance of Compliance. Make sure you are complying with all DEA registration requirements. Failure to follow them can result in discipline by the DEA and state licensing boards. One of the most common failures is for those practices that are dispensing controlled substances such as weight loss clinics who dispense phentermine. 

Compliance is not difficult but it does require setting up systems where all providers and staff must follow the rules. Failure to comply with these rules could result in criminal violations. Thus, following DEA rules helps protect everyone. We would rather focus on compliance rather than representing businesses and individuals when there have been violations but often our clients did not know the rules until there was an audit or visit by the DEA, government agency or licensing boards. Take the time and make sure you and your office is in compliance. One good thing is to review your compliance at the beginning of the year so that it is reviewed on a regular basis.

Posted by Tracy Green, Esq.

Green and Associates, Attorneys at Law

Nurse Practitioner Bill Suffers A Setback in California

Nurse practitioners in California suffered a setback in their ability to practice independently of physicians if they are part of a medical team such a clinic or group practice. On August 30, 2013, Senate Bill 491 (Hernandez), which would remove patient barriers to health care services by permitting nurse practitioners in California to practice to the full extent of their training and expertise was held in the Assembly Appropriations Committee. The bill was not voted upon and will not move during this legislative session. The California Medical Association vigorously opposed this bill. The Los Angeles Times' article on SB 491 provides more background on the lobbying and issues present. 

Under current law, NPs have a difficult time providing services at the point of care because of requirements for physician approval to initiate or continue care that patients need.  This bill would increase autonomy for NPs to be able to provide this care. The California Association for Nurse Practitioners viewed SB 491 as especially important with the coming implementation of the Affordable Care Act, and the expected influx of up to 7 million new patients into the health care delivery system in California. The Los Angeles Times wrote an article indicating that this is a step in the right direction.

The argument in favor of the bill was that NPs would not be performing outside of their level of education and training, but would be utilized to their full practice potential without the archaic and restrictive barriers that prevent patients from receiving high quality, effective care. In addition, 18 other states and the District of Columbia permit autonomous delivery of primary care services by nurse practitioners.  

We can expect to see a revised bill presented next year regarding expanding the use of nurse practitioners in clinic and group practice settings.

Posted by Tracy Green, Green and Associates, Attorneys at Law

You can reach Ms. Green at tgreen@greenassoc.com or 213-233-2260

California Board And Bureau Investigations: Frequently Asked Questions by Licensed Professionals During Board Investigations And Requests For Records

In our practice, we represent a variety of professions before the California administrative boards and bureaus. Here are nine frequently asked questions and answers:

1.  I have received a request for a patient or client file from my licensing board. What should I do?

This is the time to be the most proactive. The earlier you can prevent an investigation from going forward, the better. Once an Accusation or disciplinary charge is filed, it is difficult to unwind it. We find that often charges were filed because the professional did not adequately address the investigation at an early stage.

Each case is different and varies upon the facts. No one strategy works for each case. However, an experienced objective attorney can help you prevent complaint from turning into disciplinary charges or mitigating the problem.

One important piece of advice that applies to most cases (but not all): do not simply produce the file and nothing else. Here are some of the things, among many, that can be done at this early stage:

(1) Take the opportunity to ensure the board has full access to all relevant information.

(2) If there were problems with this particular client or patient, a letter or memorandum summarizing the history, facts and issues will help the investigator evaluate the case.

(3) Have an experienced attorney or other objective party review any submissions since you will have to live with them for several years if the case is investigated further and/or is the subject of disciplinary proceedings. Remember that everything you do is evidence.

(4) If there is significant handwriting in the file, dictate the notes so the handwriting is easy to read. Have your attorney or other objective party ensure that the records are easy to understand.

(5) If this case had a bad or poor outcome (even if that is part of the risk that was disclosed to the client or patient), it may be useful to have your attorney hire an expert and evaluate the file in order to help prepare a thorough response explaining the case or matter.

(6) The board can be contacted to determine what stage the investigation is at so that the appropriate response. This is often easier for your attorney to do since the investigator may be open with him or her. In addition, anything you say is evidence and even impromptu comments like "I didn't do anything wrong" or "I don't remember this person" can be used against you later in ways that are difficult to anticipate when they are said.

(7) Do not alter, backdate or create any records unless such records are properly created and dated.

(8) Once you hire an attorney, have him or her send a letter of representation so the board contacts the attorney and does not show up at your office for a surprise interview.

2.  My licensing board is accusing me of misconduct. What should I do?

A governing board will often state that it is investigating suspected fraud, abuse or other misconduct, but not tell you specifically why. You need to find out the facts supporting the board's accusation. An experienced attorney can help you immeasurably with this process. Once the board is notified that you have hired an attorney, it is not permitted to contact you directly. The attorney can speak with the agency's investigators to learn the factual basis of the allegations. The attorney can then direct you to take specific steps to protect your license.

3.  Why can't I (or shouldn't I) talk to the licensing board myself?

You do not need an attorney to communicate with your licensing board, but it is an excellent idea. An attorney can speak on your behalf and obtain information without making any admissions that might hurt you. Anything you say to a board, even though it may seem innocent, might be used against you later. In addition, it is difficult for you to be objective and create an intelligent and forward thinking strategy.

4.  I already spoke to the licensing board. Is it too late to hire an attorney?

No. Licensing boards do not always act quickly. An attorney can help you find out what the board is intending to do. The attorney may be able to help you submit additional information or documents for the board to consider. The attorney may also be able to negotiate a settlement that would allow you to keep your license.

5.  The licensing board has presented me with a proposed disciplinary order. Do I have to sign it?

No. You can reject it and try to negotiate other terms. If you and the licensing board cannot agree on terms, the board will likely bring formal disciplinary proceedings.

Having an attorney advise you is important. Attorneys who specialize in administrative law understand both the board's concerns and the nature of your profession. This insight often enables them to negotiate settlements that satisfy the board's need for oversight as well as your need to maintain profitability.

A settlement enables you to avoid formal disciplinary proceedings. When a settlement is not possible, you want representation by an attorney who is familiar with procedural rules as well as the laws and regulations governing your profession.

6.  I have an administrative hearing scheduled before a licensing board or regulatory agency. Do I need an attorney?

You are not required to have legal counsel, but it is an excellent idea. The agency will be represented by an attorney and, in fact, you will be at a disadvantage without one.

Many procedural and evidentiary rules must be followed in presenting a defense. Even if you feel you have a good defense, you might not be permitted to present it if you don't follow the rules. An attorney who specializes in administrative proceedings will be able to present your defense in the proper manner.

7.  I have been charged with or convicted of a crime. Will this affect my license?

It likely will. Many regulatory agencies require that you report a criminal charge or conviction, even if it seems unrelated to your practice. Certain charges or convictions may result in the suspension or revocation of your license. This is one reason why it is critical to coordinate any criminal defense with an attorney specializing in administrative law and board defense at the earliest possible stage.

An attorney specializing in administrative law will help you determine the reporting requirements relevant to your profession. If reporting is required, the attorney will help you present the facts in the best light possible. If you fail to report, this can be considered unprofessional conduct and can be used against you later. Honesty is the hallmark of professionalism and a subsequent dishonesty (or even lack of forthrightness) while you are defending your criminal charge can harm your professional license. If you have negative facts in your criminal case, you can win your criminal case and still face discipline from your board in many circumstances. We advise a global strategy that looks forward to the next several years and includes all criminal, civil, and administrative consequences.

8.  Can I apply for a license if I have a criminal record?

It is difficult, although not impossible, for an applicant with a criminal record to obtain a professional license. An attorney skilled in licensing law can help you submit evidence of your character and rehabilitation, so as to present your application in the best light possible. In short, you will need to have a thorough application, numerous support letters, and significant documentation to explain the charges and why you have changed and what you have done to warrant you being granted a professional license. It helps to have an objective attorney who can help you build the best administrative record possible.

9.  I want to avoid problems with my licensing board. How can I make sure I operate my business in compliance with the law?


Many professionals retain a law firm to review their business structure and office policies to ensure they are in compliance with the laws and regulations governing their business. An attorney skilled in administrative law will have knowledge of the common pitfalls for your particular business and can show you where your practice might be vulnerable to administrative scrutiny. The attorney can assist in educating your staff about the law relevant to your practice through in-office presentations or the preparation of formal office policy and procedure handbooks. It is also common for professionals to retain a law firm on an ongoing basis for a monthly fee to have access to an attorney to questions as they arise.

Posted by Tracy Green, Esq.  Any additional questions or comments should be directed to tgreen@greenassoc.com.  Tracy Green is a principal at Green and Associates. The firm focuses its practice on the representation of professionals, particularly health care professionals including individual physicians, corporate providers and group practices.

Tracy Green is one of the best Los Angeles Board attorneys, one of the best Los Angeles professional license defense attorneys and is committed to excellence.  You can email her at tgreen@greenassoc.com or call her at 213-233-2261.   Their website is: http://www.greenassoc.com/