The last thing you want to do is get into legal trouble when you start a business or begin practicing as a nurse practitioner! I know many medical providers who got in trouble because they were doing dumb and shady things! Don’t be that person. Work smart, work hard, and stay legal!
When you are a practice owner, you are ultimately responsible for what happens. You must know what is legal and what is not. Here are a few actionable steps you can take that I have learned through my nurse practitioner journey to keep you safe:
1) Do not accept money from the government! When you accept Medicaid and Medicare, you are accepting money from the FEDERAL GOVERNMENT. What does this mean? If they don’t like what you are doing, they will take their money back from you! If they feel like you are overcharting and overcharging, they can investigate your charts at anytime they want. There is NOTHING you can do about that. If they want to audit you, they can, and they will!
I know 2 doctors who went to PRISON because Medicare did an investigation on their billing habits and found $700-$800 in fraudulent charges. YES… $800… They had to go to white collar camp cupcake prison for 3 months for Medicare fraud. Was this intentional? I have no idea. Is there more behind the story? I am sure there is, but regardless, that is a felony and warrants prison time if the government waves their wand and says so.
If you accept federal dollars for anything, you better make sure you are playing by their rules. Do not deviate from these rules, if you do so, you are committing a FEDERAL crime. Make sure you are not overbilling. Make sure you are only performing medically necessary interventions. Do not make deals with shady compounding pharmacies or other third parties that involve billing Medicare or Medicaid. Play by the rules, be honest, and there is nothing to worry about. But still be cautious, the government doesn’t take kindly to people who steal money from them.
2) The same rule applies with private insurance companies! You are taking money from a third party. If they want their money back, they will take it back. If they feel like what you are doing is fraudulent, they can investigate you and bring charges toward you. Again, when you accept insurance, you must play by their rules. Do not over charge for services and you will be fine. This is why having a cash practice makes your life so much easier…
3) Do not allow your assistants or nurses to sign off on prescriptions for you. Jeez… I have known a few providers who got in trouble for this laziness… Listen, if you are issuing controlled substances from a practice and you cannot physically be there to issue a prescription to the patient, that patient can wait. Do not sign a bunch of prescriptions and allow others to fill them in for you. JUST DON’T DO IT. This kind of thing results in your license being revoked.
4) Do not commit tax evasion! Listen, the government wants their share of your money. There is no way around this. You must pay Uncle Sam or he will come after you. Do not hide money in different accounts. Do not make fraudulent expenses up so you can take money out of your business. Saving yourself a thousand dollars here and there in taxes is not worth it. Just pay your taxes. Now, I am not saying you can’t reduce your tax obligations legally through your business, because you can, and you should! You would be a fool not to take advantage of the tax code. You need to hire a competent CPA and understand how to decrease your taxes legally if you are operating a business!
5) Do not operate a pill mill. If you decide to open up a practice that issues controlled substances such as testosterone, Suboxone, opioids, stimulants, etc. you better be practicing within the “standard scope” of medical practice. When the DEA prosecutes people, this is how they determine if what you are doing is shady/illegal or not. They will ask: Are you deviating from the standard practice?
Are you just handing out testosterone prescriptions to everyone without obtaining lab work? Are you handing out 60-day prescriptions for Suboxone without checking urines? Are you issuing a controlled substance without doing a physical exam first? These are the things you must be aware of when you are prescribing controlled substances.
The DEA and your states board of pharmacy are monitoring the prescription monitoring program DAILY. They look for trends in prescribing habits. There are algorithms that flag certain behaviors. If there is a red flag next to your name due to your prescribing habits, then they can and they will come ask you some questions. I talked with a lawyer once, he told me “Do not be the number 1 person in your area for prescribing any type of controlled substance. It makes you a target.” Those are wise words. Just like anything in life, you must practice moderation. Just because you THINK you are doing everything right, does not mean someone else might have a differing opinion. When it comes to controlled substances, just make sure you are doing everything right.
6) Handle patient complaints in a timely fashion! How are our licensing boards notified of problems in our practice? By someone complaining! You don’t want to deal with a board of nursing complaint… There was a physician in my area who was operating an opioid pill mill. This guy was issuing thousands of opioid prescriptions monthly from his practice. He got away with this for 5 years until a patient over dosed. The patient’s family reported this physician’s prescribing behavior to the board because his actions were directly responsible in this person’s death. What happened next? An investigation was launched, and this guy is now spending the next 5 years in federal prison. He was getting away with it until someone reported him…
Again, just because you think what you are doing is correct, does not mean the board will think so. If you anger a patient or god forbid are responsible for an adverse event, the board will find out once someone notifies them of this. When they do, they will investigate your behavior and disciplinary action will occur. This could be anything from a warning to your license being revoked.
These are the top 6 actions you can take to make sure what you are doing is legal and safe. I had a lawyer friend tell me one time:
“Most people get in trouble over money. When it comes to white collar type crime, it always involves money, especially federal money. I have defended many medical providers who were unknowingly committing Medicare fraud. Be careful.”
So, listen up friends, be careful. We have been given an enormous amount of responsibility as a nurse practitioner. Do not take advantage of this. You can get tempted to take short cuts when you start a business. When you start seeing the money coming in, that little devil called greed can pop its head up and trick you into taking short cuts. You need to have the discipline not to fall into this trap. Do not take money from the federal government, pay your taxes, and provide safe care. If you do this, there is little to worry about!