Professional Medical Staff Discipline in Illinois
For over 40 years, the health law attorneys at Goldberg Law Group have been representing physicians facing disciplinary action (i.e. an “adverse action”) by hospital medical staffs.
Medical staff discipline or adverse action can take a number of forms, including:
Summary suspension of clinical privileges
Restrictions on ability to exercise clinical privileges
Termination of medical staff membership and/or clinical privileges
Revocation of medical staff membership and/or clinical privileges
Non-renewal of medical staff membership and/or clinical privileges
Denial of appointment/reappointment to the medical staff
In Illinois, hospitals are required to have medical staff bylaws that contain due process rights for physicians facing disciplinary action. Except in the rare event of a summary suspension, which cannot be imposed unless there is actual documentation or other reliable information that an immediate danger exists, the hospital must offer the physician a hearing and allow the physician to exercise his or her due process rights before imposing any disciplinary action.
The specific due process rights hospitals are required to provide physicians are contained in the Federal Health Care Quality Improvement Act (HCQIA), the Illinois Hospital Licensing Act, and in the medical staff bylaws applicable to each hospital. Due process rights available to physicians in hospital hearings include:
Written notice of the reasons for the proposed disciplinary action, including all reasons based on the quality of medical care, or any other reason;
The right to call, examine and cross-examine witnesses;
The opportunity to present and rebut evidence;
The right to be represented by an attorney or another person of the physician’s choosing;
The right to have an official record made of the proceeding; and
The right to submit a statement at the close of the hearing.
Unfortunately, many physicians faced with disciplinary action do not know that they have the right to a hearing or the right to be represented by an attorney. Protecting the legal rights of physicians faced with disciplinary action is top priority for the health care attorneys at Goldberg Law Group. We provide strategic representation designed to invoke and preserve all due process rights available to physicians facing medical staff discipline.
Often times, in the process of pursuing disciplinary action against a physician, a hospital will fail to follow its own medical staff bylaws, or it is discovered that the medical staff bylaws do not comply with Federal or State law. In Illinois, medical staff bylaws are a contract between the hospital and the members of the medical staff. Physicians subject to disciplinary action may, in certain circumstances, file a law suit against a hospital to obtain a court order requiring the hospital to follow federal and state laws and its own medical staff bylaws, or to prohibit the hospital from taking an action in violation of its medical staff bylaws or federal or state law.
A cascade of negative consequences can result from a single disciplinary action. If the action was based on the professional competence and/or professional conduct of the physician, it is reportable to the National Practitioner Data Bank (NPDB). The NPDB is a national clearinghouse that accumulates negative information about physicians. Information reported to the NPDB is available to other hospitals and health care entities, state licensing boards, federal agencies, state agencies administering health care programs, health plans, private accreditation organizations, peer review organizations and private accreditation organizations. These entities regularly obtain information from the NPDB about negative actions taken against about physicians. Moreover, a physician must voluntarily disclose disciplinary action taken against him or her when credentialing or applying for licensure or certification.
The consequences of a single adverse action taken against a physician’s medical staff membership or privileges will follow a physician around for years, regardless of where he or she practices. If your privileges have been summarily suspended by a hospital or you have been given notice of a proposed disciplinary action, it is imperative that you seek advice from an experienced health care attorney immediately.
At the Goldberg Law Group, our Illinois health care attorneys have a wealth of experience representing physicians in medical staff disciplinary matters. Some of our successful outcomes are described below:
An Illinois appellate court prevented a hospital from reporting a summary suspension of a physician’s clinical privileges to the NPDB. Thereafter, the Court reversed and remanded the hospital’s summary suspension finding that the hospital failed to comply with its own medical staff bylaws by not providing relevant information requested by the physician that was necessary to defend against the allegations.
An Illinois appellate court reversed a hospital’s decision to proceed with a recommendation to terminate a physician’s medical staff membership and clinical privileges based, in part, on its failure to complete a prerequisite in the medical staff bylaws before recommending disciplinary action.
An Illinois state court enjoined a hospital from reporting a surgeon to the NPDB and reinstated her membership and privileges at the hospital based on findings that the hospital had violated its medical staff bylaws in terminating the surgeon’s medical staff privileges.
An Illinois state court entered a temporary restraining order enjoining a hospital from reporting the revocation of a physician’s cath lab privileges to the NPDB based on violations of the medical staff bylaws.
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Practice Areas in Illinois
Medicare & Medicaid Audits
In the current regulatory environment, healthcare providers face increasing scrutiny from government healthcare programs. Goldberg Law Group provides strategic legal representation in all types of Medicare and Medicaid audits and claim reviews.
Third Party Payer Audits
Third party payer audits present a significant financial risk for physicians, industry service providers, and medical groups. Our attorneys have years of experience representing physicians and other providers in in audits and claim reviews initiated by commercial payers.
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Medical Cannabis Law
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Our attorneys are vigorous advocates for physicians in medical staff hearings and appeals. We work hard to protect and preserve the rights of Illinois and Arizona physicians under the medical staff bylaws and state and federal laws and defend adverse actions that threaten your membership and privileges.
Medical Staff Credentialing & Peer Review
Our healthcare attorneys routinely counsel and advise physicians with issues related to medical staff credentialing and peer review. We identify and safeguard your rights under the medical staff bylaws and applicable laws and make sure your status is presented in the most favorable light.
Healthcare Merger & Acquisition Transactions
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Healthcare providers who are interested in forming and organizing their own business must adhere to a unique set of laws and regulations. Our attorneys rely upon industry-specific knowledge gained through 40 years of experience to advise physicians, chiropractors and other healthcare service providers through the process of forming and organizing their own business.
Corporate Disputes, Licensing & Litigation
The lawyers at Goldberg Law Group provide legal advice and representation in business-to-business disputes and in conflicts that arise amongst individual stakeholders.