Telemed in different state will i be in trouble?

[Crt2rn]

So I am license APRN in one state. I briefy did telemed for braces which I ended call people in about 3 states I am not licensed in. The tele company told me I did not have to be licensed in other states as long as I had PECOS because its only a brace and not a medication. I am a newer NP and believed them. What happened was they did clerical error on my electronic signature and put MD and not APRN and I didn't know it. Whoever checks on these companies reported to my state board I was using MD. Telemed people admitted it was their error and I never said I was MD, they sent it to board and all is good with my board. My board however said you are not going to be in any trouble here because it wasn't our state but we will send this to the other states because I didn't have license there. I only did this about 2 months. So there's not a lot of pts. I really thought it was ok and I am thinking now its not. What is your all opinion on what will happen with this?

[guest416560]

Technically you were practicing without a license in those states where you are not licensed. It is a crime but not one where I'm sure the other states BON is going to come looking for you. They usually have bigger fish to fry.

[Crt2rn]

That's exactly what I am hoping!! I swear I didn't knowingly do something wrong on purpose. This is so messed up. Sad thing is I will have 3 different boards to deal with.

[Goldenfox]

The company gave you bad information, and I suspect that they did this knowing full well that it is illegal. Braces are obviously not medication but they are still a treatment that you prescribed for a condition that you or another provider diagnosed. If these are Medicaid/Medicare patients I would be more concerned about CMS audits than about the boards of nursing coming after you. It isn't so much incidence that matters, but occurence. Your name and electronic signature is out there on documents for those few patients that you prescribed the braces for. To you it was an error, to them its fraud.

Not legal advice, but I would apply for the other three state licenses anyway---even if you let them lapse afterwards. If they start auditing at least they will see a license number linked to real provider name. If they see no information at all on a provider who has been prescribing equipment and treatments that the CMS was billed for that will most definitely raise red flags.

I was once talking to a recruiter for a telemedicine company who was trying to get me to do a part-time per diem telephone thing to write prescriptions for DMEs. What made me not do it was her responses to the questions I asked about how it works. They wanted me to call patients in states that require a collaborative agreement with an MD (who is licensed in the state) and also malpractice Liability Insurance---neither of which the company provided. To my surprise, she tried to convince me that there are other NPs working for them who don't have the collaborative agreements or malpractice insurance and that it was up to my discretion. She knew very well what the laws are and she straight out lied about it. She didn't care. She doesn't have to care. If trouble comes, its me, the NP, that law enforcement would actually come after, not her or the company. Very easy for them to dissolve their company and disappear, then reemerge with a different name in a completely different area as a new company.

[pro-student]

It's unfortunate that the company gave you bad information and even more unfortunate that you listened. You clearly practiced without a license in each of these 3 states since you provided a service that would constitute advanced practice nursing or medicine in the state. Why else would the company have hired you if they didn't need you services which would have demanded a license? Each order you called in in a state you weren't licensed in was committing a crime and those states could choose to overlook it or they could choose to prosecute each criminal act. Either way, it's much better, at this point, to be proactive and at least get expert legal advice rather than waiting around hoping no one notices. It is unlikely anyone will buy the excuse that the company gave you bad information and ignorance is no defense.

It varies by state, but there is generally also a presumption that the care you provided was negligent my the mere fact of being provided without being appropriately credentialed. While ordering braces is probably quite low on the medical liability scale, if anyone got wind and wanted to make a fuss, it would be extremely difficult to defend against a suit in which you didn't even know you had to be licensed to provide care. Any Liability Insurance will likely be void as well leaving you personal liable.

I say this not to scare you but to try to convince you get out if front of the problem while you still can. Trying to retroactively get a license in the states or just doing nothing will likely look like you are trying to conceal a criminal act and would make everything exponentially worse. Since the penalty for practicing without a license can be 1-8 in prison for each act and include fines as well as the potential for liability, it really is in your best interest to try to resolve this professionally and proactively. At least talk to a lawyer in each of the three states and they will be able to give you a sense of the potential paths forward. And hopefully someone else can learn for your experience and avoid a situation like this.