Mr. Kreager warns that determining whether a practice is under criminal investigation may be difficult. “Usually, ongoing criminal investigations are confidential. In federal criminal investigations, you are likely dealing with sealed indictments that are not accessible by the public,” he said.
Mr. Kreager urges physicians to closely scrutinize pain man- agement clinics before getting involved in any capacity. “Pain management clinics are squarely within the crosshairs of law enforcement agencies. Physicians should ask for records that indicate how many controlled substance prescriptions the clinic writes and obtain a summary of prescription patterns to identify whether controlled substances are being overpre-
scribed and written without documentation of medical neces- sity,” he said. Purchasing an existing practice has additional inherent le- gal risks that make due diligence essential. “Due diligence will help purchasing physicians uncover pending, unresolved claims from vendors, former employees, and payers. If physicians assume ownership of a practice that was engaged in inadequate or fraudulent documentation of Medicare or Medicaid claims, their medical licenses could be at risk,” Mr. Kreager said.
He adds that physicians could find themselves in tax trou- ble if the practice’s prior owners failed to pay employment taxes or contributions to employee retirement plans.
PAIN MANAGEMENT CLINIC CERTIFICATION FACTS
A pain management clinic cannot operate in Texas unless the owner and operator is a medical director who has an active, unrestricted Texas medical license and a certificate of registration for the clinic. In addition, an owner, employee, or person with whom the clinic contracts for services may not:
• Have been denied a license by the Drug Enforce- ment Administration (DEA) or a state public safety agency allowing him or her to prescribe, dispense, administer, supply, or sell a controlled substance;
• Have held a license issued by DEA or a state public safety agency in any jurisdiction, under which the person may prescribe, dispense, administer, sup- ply, or sell a controlled substance, that has been restricted; or
• Have been subject to disciplinary action by any licensing entity for conduct that was a result of inappropriately prescribing, dispensing, administer- ing, supplying, or selling a controlled substance.
Also, anyone who has been convicted of, pled no
contest to, or received deferred adjudication for a felony or misdemeanor for distributing illegal pre- scription drugs or a controlled substance cannot own a pain management clinic, wholly or in part. Each year, pain management clinic medical direc-
tors must ensure that all employees are properly licensed (if one is required for the position), qualified
for employment, and have at least 10 hours of con- tinuing medical education on pain management. Certificates are valid for two years. Certificate holders have a 180-day grace period from the expira- tion date to renew the certificate; however, a clinic may not continue to operate while the certificate is expired. Regulations on the registration and operation of pain management clinics do not apply to:
• A medical or dental school or associated outpa- tient clinic;
• A hospital, including any outpatient facility or clinic;
• A hospice established under state or federal law; • A facility maintained or operated by the state; • A federal clinic; • A nonprofit health organization certified by the Texas Medical Board;
• A clinic owned or operated by a physician who uses other forms or treatment, including surgery, and writes prescriptions for a majority of his or her patients; or
• A clinic owned or operated by an advanced prac- tice nurse who uses other forms of treatment with the issuance of a prescription for a majority of the patients.
Source: Texas Medical Board April 2013 TEXAS MEDICINE 23
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