UR serves to verify the medical necessity of hospital admissions and specific medical procedures. However, by intruding into the traditional physician-patient relationship, UR programs raise a host of liability issues. The Types of Utilization Review UR is used in one form or another by government payers such as Medicare, private insurers, health maintenance organizations HMOsand self-insured employers.
It gives advice in response to the question: Does this sound correct to you? No, this does not sound completely correct and such advice may cause great damage to any defenses you may have, even if you are totally innocent.
Most states, Florida included, do not require you to make any statement to an investigator or attorney working on a BON complaint, and we recommend that you not do so. In fact, under Florida law, your constitutional right to not make any statement that might help to incriminate you applies to such proceedings.
Nurses are often falsely accused of misconduct or wrongdoing by patients, families of patients, employers and rivals.
Most states do have adequate procedural safeguards in place that, if used by the nurse, will help to ensure the correct outcome of the matter. However, you must first know what these rights and safeguards are, and then know how to use them to your advantage in such a proceedings.
Very few attorneys are experienced in such matters and even fewer nurses are. You should think of the investigation in the same light as a criminal investigation against you if you were wrongfully accused of a crime. In the case of a BON complaint, you can lose your license, lose your career, and be assessed monetary fines in the thousands of dollars.
Why would you want to contact the investigator in such a matter and make statements that can later be used against you, if you don't have to? In most states, Florida included, the burden of proof is on the state to prove every element of the case against you.
However, if you make any statements to the investigator or the attorney for the Boardoral or written, this can be used against you. Even the simplest, most innocuous statements can cause you tremendous difficulty, because anything you say is something the state is no longer required to prove in an investigation or a hearing.
For example, the state may not have an admissible document or a witness who is available at the time who can state that you actually saw or treated the patient.
Without being able to prove this, the state may not be able to prove any charge against you. Yet if you make a simple statement that you did treat the patient, the state no longer has to introduce any other proof of this. You have helped the state to prove its case against you without even meaning to do so.
You have now made the case against you quicker, easier and less expensive for the state to prove; you may have made the case against you possible to prove when otherwise the state would not have been able to prove it at all. It has also been our experience that BON representatives do not have the time or resources to answer every question you may have.
Furthermore, BON representatives are not able to give you legal advice on what to do. Even if you do speak with an attorney representing the BON, that attorney is not allowed by law to give you legal advice.
Remember, the attorney representing the BON works for the state and is similar to a prosecutor. If you were charged with a criminal offense, would you call up the attorney prosecuting you and ask for her or his legal advice on what to do?
We recommend that if you receive any notice or indication that anyone has filed a complaint against you with the BON or any other licensing agency that you do not contact the BON, its investigators, or any of its representatives.
We recommend that you immediately contact an attorney who specializes in defending nurses before the BON. Be sure to ask the attorney how many similar cases has she or he actually handled before the Board of Nursing.
I received in the mail a letter from the Florida Department of Health with a "Nondisciplinary Citation" in it. What is this and what should I do? In certain "minor" disciplinary infractions, the Florida Department of Health DOH is authorized to offer the option of accepting a Nondisciplinary Citation or a Notice of Noncompliance.
This will often carry with it a small fine. Timely acceptance and compliance will not result in discipline being reflected on your professional license under present laws and regulations. Physicians, dentists, nurses and other licensed health professionals may be offered these in the event of minor advertising infractions, failure to have the required continuing education courses or requirements, failure to renew a license on time, or other minor infractions.
In all cases the licensed health professional will be required to correct the deficiency as part of the process of disposing of the offense in this manner. It is usually advisable to accept such a Nondisciplinary Citation or a Notice of Noncompliance, provided you can pay the fine and obtain documented proof you have corrected the deficiency within the time specified in the document.
If you do, you must be sure to promptly and properly comply with every requirement contained in the document. If you have proof that you did not commit the offense in the first place or there is other litigation involved, you may desire to not accept the offered disposition of your case.
However, we recommend that you consult with an experienced health attorney familiar with such matters prior to making such a decision. If you have received one of these, this will mean that a review of the case by a staff member of the Florida DOH indicates that you were out of compliance with laws or rules and there is a superficial case against you.tort_law - Download as PDF File .pdf), Text File .txt) or read online.
any information or insights he possesses bearing upon why the deal might be to the corporation's disadvantage. a peer review committee of a hospital may have the responsibility of unearthing and discussing even flimsy allegations about professional misconduct. and.
schools. Educators are especially vulnerable to suits involving tort liability issues. School employees have the responsibility to maintain the safety and welfare of their students.
Even under the best circumstances, unfortunately, accidents involving students take place in schools. It may also be urged that efficiency, and proper deference to the peer review process, justify delaying a trial of a civil action under section until peer review proceedings involving the same hospital staff physician are complete.
This article will focus upon three particular types of business tort claims in the context of employment law: (1) fraud and misrepresentation claims; (2) certain fiduciary duty claims; and (3) claims involving inducement to breach, interference with employee relations, and "pirating away" employees.
Start studying Combo with Chapter 1 - Medical Law & Ethics and 5 others. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Handles cases involving estates of the deceased, also known as estate court. Provides for peer review of physicians by other physicians and healthcare professionals.
o Process for peer review o Mechanism by which medical staff can be terminated • Focuses on one's duties to others and others' rights • The Supreme Court decided that for the purposes of tort law, an impaired life was not worse than nonlife and for that reason, life itself was not, and could not, be considered an injury.