(September 20, 2013): Like other physicians around the country, Texas physicians are currently facing increasing pressures to ensure that their medical necessity determinations, coverage assessments, documentation, coding and billing activities meet both Medicare's requirements and those of private payors. While their duties and responsibilities have continued to increase, reimbursement rates have steadily fallen. Notably, Texas physicians are also obligated to ensure that their practices comply with each of the professional tenets of the Texas Medical Practice Act. As many Texas physicians can attest, the Texas Medical Board will not hesitate to investigate and pursue disciplinary action.
I. Texas Medical Board Complaints Resulted in 41 Disciplinary Actions in August 2013:
Late last month, the Texas Medical Board met from August 29-30, 2013 to consider a number of pending disciplinary cases that have been levied against Texas physicians. By the end of the meeting, the Texas Medical Board had disciplined 41 licensed physicians and issued two cease and desist orders. A review of these action can be quite helpful from a "compliance" standpoint.
II. Overview of the Reasons for Disciplinary Action:
As the summary chart below reflects, a preponderance of the disciplinary actions taken by the Texas Medical Board involved "Quality of Care Issues" under the Texas Medical Practice Act. Also prevalent among the disciplinary actions were "Non-Therapeutic Prescribing" and "Unprofessional Conduct". The ultimate disciplinary actions taken serve to highlight the various types of sanctions that the Texas Medical Board may choose to impose, depending in large part on a physician's prior disciplinary record and the specific facts of each case. The various sanctions imposed included:
Agreed Orders for Reprimands.
Peer Monitoring.
Continuing Medical Education (CME).
Agreements to Refrain [from Certain Conduct]
Revocation of License
Suspension of License
The following chart provides a summary of the various disciplinary actions taken by Texas Medical Board during its August meeting.
| Quality of Care | Unprofessional Conduct | Other States Action | Physician’s Medical or Mental Condition | Violation of Prior Order | Non-Therapeutic Prescribing | Criminal Behavior | Medical Record Keeping | Other | |
|---|---|---|---|---|---|---|---|---|---|
| Total Actions | 11 | 5 | 2 | 7 | 3 | 7 | 2 | 1 | 3 |
| Agreed Order | 9 | 3 | 2 | 7 | 3 | 6 | 2 | 1 | 3 |
| Mediated Agreed Order | 2 | 2 | -- | -- | -- | 1 | -- | -- | -- |
| Public Reprimand | 2 | 1 | -- | -- | -- | 2 | 1 | -- | 1 |
| Monitoring of Physician | 2 | -- | -- | -- | -- | -- | -- | -- | -- |
| Agreement To Refrain From Practice | 4 | -- | 2 | 1 | -- | 3 | -- | -- | 1 |
| CME | 11 | 5 | -- | -- | 3 | 5 | 1 | 1 | 1 |
| Fine / Penalty ($) | 6 | 2 | -- | 1 | -- | 3 | -- | 1 | 1 |
| Suspension of License | -- | -- | 2 | 1 | -- | 1 | 2 | -- | -- |
| Revocation of License | -- | -- | -- | 5 | -- | 1 | -- | -- | 1 |
As the chart shows, the Texas Medical Board revoked the license of physicians during the August meeting primarily based on the "Physician's Medical or Mental Condition" . The actions of the Texas Medical Board illustrate the role of patient and peer complaints in the investigative and disciplinary process. Each action announced in August, 2013 involved an Agreed Order or a Mediated Agreed Order. The negotiation of an Agreed Order and the mediation of a Mediated Agreed Order may be best accomplished by a physician with the involvement of an attorney experienced in dealing with the State Medical Board and who understands the remedial and penalty processes typically invoked by a Board of this type. Should you ever find yourself subject to an investigation by the Texas Medical Board or another State Medical Board, it is essential that you retain experienced health care legal counsel to represent your interests.