The Dangers of a Medical Board Investigation: How to Protect Yourself

Mark Crane

Disclosures

July 24, 2018

In This Article

Prescribing and Documentation Gets Board Attention

State boards have focused intensely on the opioid epidemic and often work hand in hand with the Drug Enforcement Agency when investigating physicians.

Any hint of overprescribing is likely to spur the board's interest. "The board is checking doctors' records to see if there is a medical necessity for the kind and amount of drug prescribed. Not having thorough records makes the case hard to defend," Chapman said.

"You have to medically justify what you did and records are essential. Many doctors are too lax, too willing to believe a patient who 'lost' his prescription. Let's say the patient has lower back pain. Did the doctor order tests to confirm that there's evidence to warrant his claimed level of pain? Is the patient doctor-shopping? Some doctors are unfortunately gullible."

All states have databases physicians must check to track a patient's drug prescription history. If you can't prove that you checked the database, state boards will act and the lack of documentation makes for a weak defense.

In Ohio, the state system shows all controlled substances taken by a patient. "Is the patient getting drugs from other doctors? The board wants to see copies of the report or at least documentation that the prescribing doctor reviewed them," Beth Collis said. "If the doctor doesn't describe the reason for prescribing opioids, he can even be charged criminally for trafficking in drugs. It can't be more serious."

Complaints to the board could come from pharmacists or even competitors, Brian Tew notes. "One physician who ran a pain clinic reported to the Texas board every doctor within 150 miles who also did pain management. It took a long time and a lot of money before all those cases were reviewed."

Treating Yourself or Family Members

Treating yourself or family members generally isn't considered advisable, and could potentially attract the interest of state boards, attorneys say.

"Some doctors think they can write any prescription," Beth Collis said. "But you can't prescribe controlled substances to yourself or family members, who must be treated as you would any other patient. Doctors argue that they don't need to document the patient encounter because they don't intend to bill the patient's insurer. Boards don't care. They want a full and accurate medical record."

"I tell doctors that if a family member wants care, they should refer them out. Let them get their own doctor. You could wind up spending thousands of dollars in legal defense costs to avoid having a relative pay a $30 co-pay to another doctor. It's not worth the risk. The same applies to providing care to medical staff. You must keep full medical records whether you bill the patient's insurance or not."

David Adelson recalls one physician who prescribed medication for his son. "He wasn't the original prescriber. But his son needed a refill. That doctor wasn't available and the nearest physician was a two-hour drive away. He thought he didn't need to keep records because he was just renewing it. The board felt otherwise and he faced a reprimand."

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