Medical providers in the military, whether service members themselves or contracted providers, can find their medical license and their livelihood under attack through a Quality Assurance Investigation (QAI). The QAI process marks the initiation of adverse actions against a provider’s ability to practice medicine in the community. It is initiated at the discretion of the Privileging Authority with the purpose of examining any suspected misconduct, impairment, incompetence, or other conduct that could adversely affect the health or welfare of a patient or staff member. However, these investigations have been initiated as a means to harass and retaliate against medical providers when subjective disagreements arise concerning patient care or in instances when a provider simply does not “fit” into his or her respective hospital or health care clinic.
Once a QAI has been initiated, the provider is often placed on summary suspension. This prevents the provider from being assigned any clinical duties involving the privilege/practice under investigation, being assigned to another treatment facility, or executing Permanent Change of Station orders to another treatment facility. When a provider has been placed under summary suspension for more than thirty (30) days, the suspension action is reported to the National Practitioner’s Databank, the provider’s state(s) of licensure, and other applicable certifying and regulatory agencies. Unfortunately, these investigations can take several months to complete and often result in the provider having to respond to attacks on multiple fronts.
After the QAI is completed, the provider is notified of the findings and recommendations of the investigating officer and provided an opportunity to respond to those findings within fifteen (15) calendar days of receipt of the investigation. It is always recommended that the provider take this opportunity to explain and justify their actions with specific patients, as failure to do so often results in total deference to the recommendations of the investigating officer.
Once the time period for responding to the QAI findings has elapsed, the investigation packet and any response submitted by the provider are forwarded to a Credentials Committee/Function, which is responsible for reviewing the report and making a recommendation to the provider’s Privileging Authority. These recommendations can range from reinstatement of the provider’s clinical privileges to restriction of privileges, reduction, and, in some cases, outright revocation of privileges.
Restriction or revocation of privileges can carry severe collateral consequences for the provider. Military members who have their privileges revoked often find themselves subject to separation proceedings as a result of the privileging action taken. This might also result in recoupment actions to recover bonuses paid to the member.
If you happen to find yourself the subject of a QAI or similar investigation into your practice, such as when you have been flagged as a “significantly involved provider,” you should always exercise the due process rights that are afforded to you and ensure you have adequate representation in the matter, as your career and livelihood depend on it.
Eric Duncan is a senior associate in Tully Rinckey PLLC’s Buffalo office, where he focuses his practice on military law. Prior to joining Tully Rinckey, Eric served in the Infantry of the United States Marine Corps. After transitioning from military service, Eric completed law school, where he conducted research into veteran groups and resources and worked as a founding member of the Veterans Legal Practicum at the University at Buffalo School of Law. Eric takes pride in defending our nation’s men and women in uniform. He can be reached at (888) 529-4543 or at info@tullylegal.com.
