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How can I check if my doctor has been disciplined for fraud?
How to Check if Your Doctor Has Been Disciplined for Fraud
Choosing a doctor is an important decision. You want someone you can trust to provide competent medical care. But how do you know if a doctor has a history of disciplinary actions or fraud? Here’s how you can research a doctor’s background and check for red flags.
What is Medical Fraud?
Medical fraud refers to doctors intentionally deceiving patients or insurance companies to gain money or other benefits. This could involve activities like:
- Billing for services that weren’t performed
- Upcoding – charging for more expensive services than were actually done
- Accepting kickbacks for referrals
- Prescribing unnecessary tests or treatments
Fraud goes against medical ethics and can harm patients. Doctors found guilty of fraud may face license suspension, revocation, fines, or even criminal charges.
Check Your State Medical Board
Every state has a medical board that licenses doctors, investigates complaints, and disciplines doctors for unprofessional conduct. To check for discipline in a particular state:
- Go to the Federation of State Medical Boards website and find your state’s medical board.
- On your state’s medical board website, look for a section like “Licensee Lookup” or “License Verification.” Here you can search for a doctor by name.
- When you pull up the doctor’s profile, look under sections like “disciplinary history” or “board actions” to see if any disciplinary actions are on record.
Disciplinary actions could include fines, probation, license suspension or revocation. These are red flags that a doctor has been found guilty of unprofessional conduct, negligence, or fraud.
What Does Disciplinary Action Mean?
If you find disciplinary actions against a doctor, don’t panic right away. Look into what the disciplinary charges were for. There’s a wide range of offenses. For example:
- Minor citation: Failure to complete continuing education, false advertising, etc. May not raise major concerns.
- Negligence: Repeated medical errors or substandard care. Cause for concern.
- Substance abuse: Could impair medical judgement. Proceed with caution.
- Fraud: Billing fraud, kickbacks. Major red flag.
- Sexual misconduct: Abuse of patients. Dealbreaker for most.
So look at the specifics of the disciplinary action. Fraud charges are especially serious. But even minor citations show a lack of professionalism.
Check the National Practitioner Data Bank
For an even more comprehensive disciplinary check, search the National Practitioner Data Bank. This national database includes disciplinary actions from all state medical boards plus:
- Federal sanctions like Medicare/Medicaid exclusions
- Hospital privilege restrictions
- Malpractice payouts
You can request a self-query to check if a doctor is in the data bank. There’s a $2 charge. Reports usually arrive within 5 business days. This gives you disciplinary records from all states in one report.
Google the Doctor’s Name
Also do some quick Google searching on the doctor’s name. Look for news articles about fraud cases or other lawsuits they may have been involved in. For example, a simple search could turn up an article like:
“Dr. Jane Smith fined $50,000 in Medicare fraud scheme”
Legal judgements and settlements can also be revealing. Try searching:
“[Doctor’s name] malpractice”
Ask People You Trust
Word-of-mouth can provide helpful insights not found online. Ask:
- Friends and family if they have any experience with this doctor.
- Other healthcare providers like your pharmacist or nurses.
- Patient advocacy groups for reviews.
They may reveal questionable behaviors or bedside manner problems that help complete the picture.
Trust Your Gut
Even if a doctor looks okay on paper, pay attention to your gut instinct during consultations. Do they seem trustworthy and ethical? Or just going through the motions without care? You want a doctor who listens and seems genuinely concerned.
Report Suspected Fraud
If you discover a doctor has been involved in billing fraud, report them right away. This helps protect other patients. You can report to:
- State medical board
- Medicare or insurance company
- Office of the Inspector General
With these steps, you can uncover red flags like fraud and make an informed choice about your doctor. Trust your gut, and keep looking until you find a caring, ethical provider you’re comfortable with. Your health depends on it!