How Do You Negotiate With OPMC If You Have A Criminal Conviction of Healthcare Fraud In Your Background?

We recently represented a client in a matter with the Office of Professional Medical Conduct where the client had agreed to a guilty plea to healthcare fraud some years earlier. OPMC wrote to the client, and in a telephone conversation, the client was advised that the only acceptable resolution was that the client had to surrender his license. The OPMC point of view was that since the client had used his medical license to defraud the Medicaid/Medicare system, he was not morally fit to have a license.

The client then contacted us and we began discussions with OPMC. When the surrender resolution was raised, we simply said that we were prepared to contest the matter at a Hearing, as there was no downside to doing so. After all, the Hearing Panel’s worst result would have been a revocation of the license, putting the client in the same position as he would have been with a voluntary surrender. OPMC then countered with an offer of some years of stayed suspension, probation, CME courses, and a practice/billing monitor. We said that any monitor was not acceptable, as the cost would have been prohibitive in relation to the amount of money the client was actually earning from his medical practice. OPMC refused to negotiate further, and a Statement of Charges was filed against the client, and a Hearing date was set.

In preparing for the Hearing, we served a set of documents that we were offering in evidence. They included a Plea Agreement in which the client agreed to wear a wire for the prosecution to obtain evidence in other cases; a Certificate of Relief from Civil Disability that had been issued to the client; proof that other defendants in the client’s criminal case had received less punishment than was being offered by OPMC in our case and proof that the client had been punished already as he was on the Medicaid/Medicare Exclusion List for the past four years.

We also submitted a witness list, which included the attorney who signed off on the Plea Agreement, a physician with whom the client was currently working, and another attorney who was a long-time friend of the client and the client himself. In other words, we made it clear that we were actually going to defend this case, and we had a great deal of evidence that we were going to utilize to try to obtain the best possible result for the client.

After receiving our evidence and understanding that we were going to contest the case, OPMC then offered a resolution that involved some years of a stayed suspension and some years of probation. This result was satisfactory to the client because it does not require anything from him other than to not have another OPMC issue over the next few years. He has no courses to take, is not actually out of practice for any time at all, and there is no monitor of any type. Since any criminal conviction is unprofessional conduct by definition, the only matter to argue at a Hearing is the amount of punishment. With this new offer from OPMC, the only wise thing to do was to accept the offer, which we did.

So, the OPMC matter is now resolved and the client will continue to practice without any license restrictions. In the near future, we will request that the client be removed from the Medicaid/Medicare Exclusion List and the chances are fairly good that we will be successful in that endeavor.

All in all, this result was the best that could have been obtained, and by agreeing to it we removed the possibility of a much harsher result from a formal Hearing.

The moral of the story is that you can put up a fight against OPMC, and when you do, sometimes OPMC comes to the conclusion that a lesser punishment is the right thing to do. If you find yourself in this type of situation, work with your attorney to find ways to make positive arguments on your behalf, and when you do that, the result can be beneficial to you.