Litigation Education: When and How to Address Board Complaints

Foreword by Kristi Wright 
Throughout a provider's career, receiving a complaint from your state medical board is not uncommon. If you receive a board complaint, please contact Curi immediately. Our Regulatory Claims team, led by Lori Oechslin, is dedicated to supporting you during this time. Lori will walk you through the steps involved.

If you receive notice from a licensure board naming you in a complaint or investigation, your first reaction may be disbelief, followed by worry. This is completely understandable. Over the past five years, we’ve seen an alarming rise in reports to licensure boards.

Feedback Curi has received suggests five key factors behind this increase:

1. Access – Online reporting has become increasingly easy.
2. Awareness – Patients visit medical websites to learn about diseases and conditions related to symptoms they are experiencing
3. Higher Expectations – In a culture driven by customer service assessments and ratings, patients expect their healthcare experience to match that of other customer experiences.
4. Social Networking – Word-of-mouth, amplified by social media channels, leads to more widespread information sharing.
5. Misunderstandings and Communication Breakdowns – The most common patient complaints stem from misunderstandings between patients and providers, where even simple miscommunications can result in patient dissatisfaction.

Fortunately, Curi is committed to defending the licensure of our insured members and clients. Within our Claims Department, we have a team dedicated to assisting you if you receive a licensure board complaint. Curi underwriting companies offer Regulatory Coverage, which helps cover attorney fees for responding to medical board complaints and investigations. Curi provides skilled counsel, experienced in dealing with licensing bodies in every state within our policy service area.
When you first receive a complaint, your instinct may be to defend yourself by reaching out directly to the licensure board. Instead, contact Curi immediately. We advise against responding independently or scheduling interviews before consulting the Curi Claims Team for guidance.

What to Do If You Receive a Notice:

1. Immediately forward the notice to your designated practice administrator (if applicable), who oversees claim reports, and will then send it to Curi. If there is no designated practice administrator, refer to the claims reporting contact information at the end of this post.
2. It’s important to report the claim as soon as you receive notice from a licensure body. Be sure to include your name, contact information, and any relevant documentation you have received.
3. Once we receive your report, a Curi Claims Associate will review the details and conduct a coverage determination.

Once coverage is confirmed, we will provide you with state-specific experienced counsel. Your counsel will guide you through the entire process, from crafting your response and reviewing and assembling medical records to enlisting experts and preparing for interviews. If needed, they will also attend the interview with you. Your counsel will keep you informed of any licensure board resolutions or further requirements. In some cases, the licensure board may require additional educational courses. Your attorney will help you identify the appropriate courses and facilitate communication of your course completion certificates to the board. The entire process, from the first notification to the conclusion of the investigation, typically takes six months to a year.

Types of Outcomes:

Most licensure board investigations are resolved as NON-disciplinary. Outcomes vary from state to state, though common outcomes include:

• No Further Action (non-disciplinary)
• No Further Action with Comments (non-disciplinary)
• Private Letter of Concern (non-disciplinary)
• Public Letter of Concern (non-disciplinary)
• Consent Order or Hearing Order (disciplinary)

Depending on your policy, you may also have Regulatory Coverage for the following situations:

• Billing error proceedings by state or federal government
• Improper disposal of medical waste
• Violations of the Americans with Disabilities Act
• Violations of provisions by Emergency Medical Treatment and Active Labor (EMTALA), OSHA, or Stark
• Unannounced on-site visits from a government agency

If you need to report a notice from a licensure board, you can complete the online form, select “Licensure Proceeding” under Type of coverage at issue, and fill in the remaining required information, or call us at 800-328-5532 for reporting assistance.

For more insights into the litigation process, listen to Dr. Gita Pensa’s podcast: Doctors and Litigation: The L-Word, Medical Board Complaints and Investigations, and watch Curi’s litigation education video, When and How to Address Board Complaints.

In our next blog, Frances Cronlund, SVP Senior Wealth Advisor with Curi RMB Capital, will guide you through how to protect your assets. 

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