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Q&A: Understanding Sanctions in Dermatology

Q&A: Understanding Sanctions in Dermatology

Fri, 10/30/2020 - 13:41

Dr Alvarado

Ms Alvarado is with the University of Connecticut School of Medicine. 

Sanctions and disciplinary actions are an ever-present threat that could result in medical license suspension and/or large payouts to address errors related to billing fraud or poor quality of care.

In a recent Letter to the Editor, published in the Journal of the American Academy of Dermatology, Savannah Alvarado and Hao Feng, MD, reviewed the characteristics associated with disciplined dermatologists in order to understand why a dermatologist would be sanctioned by the Office of the Inspector General (OIG) in the United States. Ms Alvarado and Dr Feng discussed their study and the implications of their findings in an interview with The Dermatologist.

Dr Feng is an assistant professor and director of laser surgery and cosmetic dermatology at the University of Connecticut Health Center and Ms Alvarado is a medical student with the University of Connecticut School of Medicine in Farmington.

The Dermatologist: Why did you decide to conduct this study?

Ms Alvarado and Dr Feng: We felt that there was a need for accessible and digestible information about the most common reasons that dermatologists are legally disciplined. Before we collected and organized this information, it would have been really challenging to get a general gestalt of what gets dermatologists into serious trouble. Dermatologists do not set out with bad intentions, but the concern of malpractice suits and disciplinary action is real for all of us during our daily practice.

Dr Feng

Dr Feng is with the University of Connecticut Health Center.

Our intention was that putting this information out there for the average dermatologist to read would set a comparison for self-reflection of actions and practices that could be risky. We felt it was important to learn from the mistakes of others so that we can protect us as physicians and also protect our patients.  

The Dermatologist: What sanctions and other data did you collect? 

Ms Alvarado and Dr Feng: The goal of the study was to look for trends in the most serious disciplinary action against dermatologists, so we used the LEIE (List of Excluded Individuals and Entities), which essentially catches all of the cases we were interested in. It is a list of physicians and other health care providers who were legally disciplined and now cannot be reimbursed from federally funded health care programs like Medicare and Medicaid. The list is maintained by the US Department of Health and Human Services OIG and states general demographic information and also an exclusion type determined by the OIG. We did not think the exclusion types provided by OIG were specific enough to take anything meaningful away from the list, so we searched for more details on the specifics using court documents and state medical license pages.

We ended up with demographic information (gender, MD/DO/IMG, age when disciplined, and geographic location), the OIG's exclusion type, and our own category of infractions. Our categories were financial, quality of patient care, and personal. Personal was pretty general and included everything from discipline for controlled substances to murder. 

The Dermatologist: What were some of the common sanctions and characteristics that you identified in this study? Were there any that surprised you? 

Ms Alvarado and Dr Feng: Based on the LEIE, the most common exclusion types were license revocation, suspension, or surrender and then conviction of program-related crimes (eg, criminal offences related to Medicare/Medicaid fraud). By itself, the list does not give us enough useful information. Our findings are more meaningful when you look at more specific information about why these dermatologists were disciplined. Quality of patient care, such as not complying with the standard of care, using unsafe medications, and intentional misdiagnosis, was the most common reason for ending up on the LEIE. This was followed by a lot of cases of false billing claims, which is not surprising, but to end up on the LEIE, the billing errors had to be pretty significant. Beyond this, there was a pretty big mix of causes.  

When we looked at the demographics of the dermatologists on the list, we saw a pretty significant majority were men and dermatologists over the age of 50 years. The good news is that the proportion of dermatologists on the LEIE was actually lower than the proportion of dermatologists in the population of all physicians in practice, so that indicates that we do not end up on this list as often as other specialties. 

The Dermatologist: What key takeaways do you want to leave with dermatologists?

Ms Alvarado and Dr Feng: We decided not to make our own categories mutually exclusive and we noticed that a lot of the dermatologists on the LEIE fell into more than one category. We also noticed that the behavior that caused disciplinary action in most of these physicians was pretty egregious and really did not seem accidental. Together, this paints a pretty clear picture that dermatologists who end up on the LEIE were definitely aware that their behavior was risky. Someone does not just end up on the LEIE after a bad week.

The fact that we saw a higher number of physicians over the age of 50 years might suggests that either those dermatologists are letting their guard down or have accumulated bad habits over years of practicing. It is really important that we continue to reassess the way we approach and treat patients (and also the way we run our practice) and make sure that we stay on the right path.

Our study really reinforces the importance of staying true to the basics of ethical, high quality care. If dermatologists are up to date with standards of care and treating patients with integrity and professionalism, there should not be much concern about ending up in serious disciplinary action. Beyond practicing with the patient’s best interest in mind, if you want to be vigilant about not finding yourself in trouble make sure you pay close attention to billing.


Alvarado SM, Feng H. Characteristics of dermatologists sanctioned by the Office of Inspector General: a cross-sectional database analysis. J Am Acad Dermatol. Published online October 14, 2020. doi:10.1016/j.jaad.2020.03.113

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