What Happens When the IDFPR Initiates an Investigation?
Have you received a call from an investigator or prosecutor at the Illinois Department of Financial and Professional Regulation (“IDFPR” or “Department”)? While not a welcome event, there are several important things to remember that will help you manage the process and outcome. Properly responding to an investigation and understanding the complaint process is important to protect your license, your practice, and your livelihood. As a preliminary matter, recognize that from the outset of an investigation, you have the right to be represented by counsel.
For example, when an investigator calls or reaches out via e-mail, many health care providers make the mistake of responding to an investigator, and providing a trove of information, without being represented by counsel. It is important, therefore, to record the individual’s information and communicate to him or her that your lawyer will be in touch. This is also important because over the past few years, false or scam phone calls from individuals impersonating IDFPR investigators have increased. Your counsel can verify the investigator’s identity, before providing any substantive information.
Also know that providers often have the urge to seek information about who submitted the complaint when IDFPR initiates an investigation. In our practice, we see complaints commonly submitted by a number of parties. These include members of the public (including current and former patients), out of state licensing boards, insurance carriers, and former or current employers. But also know that the Department typically keeps the identity of a complainant anonymous, so in some cases it is difficult to ascertain who lodged the complaint.
Being selective and strategic about what is submitted to an IDFPR investigator is also in your best interest, as that information can (and likely will) be used later on in the process. For example, the investigator will typically ask the licensee to provide a written response addressing the allegations in the complaint. Here again, it is important to be prudent about the information that is communicated to the investigator in a written statement. When providing a written statement addressing the allegations in the complaint, less is more.
After an investigator collects information, he or she may schedule an interview to further discuss the allegations in the complaint. This is an important step in the process, as statements made by a licensee during an interview can be used against him or her later on in the process. Your counsel will be able to advise you on these steps in the investigatory process.
After this is complete, the complaint will either be closed out or referred to the Prosecutions Unit. When a provider is the subject of a pending investigation with IDFPR, the existence of that investigation may need to be disclosed to insurance carriers and prospective employers during the credentialing process.
What Happens After a Formal Complaint is Filed?
If a complaint is referred to the Prosecutions Unit, a formal Complaint and Notice of Preliminary Hearing is filed and issued to the licensee. An administrative law judge is assigned to the matter and a series of initial court dates are scheduled.
At this stage of the process, you -- as the licensee -- are required to answer the Complaint and engage in the discovery process where documentation is produced and shared among the parties. In some instances, the Department will extend a settlement offer to the licensee, the terms of which are memorialized in a “Consent Order.”
In other instances, prior to extending a settlement offer, the prosecutor for the Department will invite the licensee to an Informal Settlement Conference. This is a meeting with the licensee and their counsel, a member of the applicable licensing board, and the prosecutor for the Department. This meeting is an ideal time for you and your counsel to work to have the Complaint dismissed, before the matter proceeds to a Formal Hearing.
If the complaint is not resolved through some form of settlement, the matter will go to Formal Hearing. However, it is important to remember that the majority of cases in the IDFPR Prosecutions Unit are resolved through a Consent Order. During a Formal Hearing, an administrative law judge will oversee your case and make recommendations to the Board and Director of the Division of Professional Regulation about the appropriate action.
Why Should Health Care Providers Pay Attention to an IDFPR Inquiry?
Many health care providers are not aware of the collateral effects that a licensing action can have on other areas of their practice. For example, if the Department takes action against your license, it can affect your ability to bill federal health care programs such as Medicaid & Medicare or be credentialed by private payors.
An IDFPR action can also result in other states taking action against your license. If a health care provider is licensed in multiple states, there may be an obligation on behalf of the provider, to report a disciplinary action in Illinois to those other entities. Health care providers should be aware of the types of events that must be “self-reported” to the Department. Failure to report specific events, such as a licensing action taken in another state, can result in the Department initiating an investigation.
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