ABCO Disciplinary Guidelines
Pursuant to its Rules and Regulations, the ABCO has the authority to revoke or suspend any Certificate issued by it and thereby revoke Fellow status. Should the action be disputed, there is a hearing mechanism for adjudication. Reasons for revocation or suspension are as follows:
1. A Certificate was issued contrary to or in violation of any Rule or Regulation of the Board,
2. The Fellow to whom the Certificate was issued was not eligible to receive or has become ineligible to hold a Certificate,
3. The Fellow made a misstatement of fact to the Board in his or her application or in other material presented to the Board, or violated any pledge made in conjunction with any application,
4. The Fellow is convicted of, or pleads guilty or nolo contender to any felony or any crime related to the provision of health care services, or is excluded from participation in any federal health care program,
5. A license to practice optometry held by the Fellow is revoked, suspended, placed on probation, or voluntarily relinquished in order to avoid potential sanctions, or restricted in any way,
6. The Fellow has engaged in serious professional misconduct or other serious misconduct adversely reflecting on professional competence or integrity.
GUIDELINES FOR DISCIPLINARY ACTIONS
Discipline cases will be reviewed by the Credentials Committee of the ABCO under the guidance of its legal counsel. The ABCO has develop the following guidelines to ensure consistency in its disciplinary procedures.
I. Limitation on Applicability
Although in most cases the outcome of an ABCO disciplinary action will track the guidance found is this document, fairness and due process require (and ABCO Rules and Regulations mandate) that each case be evaluated on its own merits. Every case is different and involves its own unique set of circumstances. Consequently, this document sets forth general guidelines only, and in certain cases deviation from the guidelines will be appropriate.
Before action against a Certificate is taken, the Fellow is entitled to a hearing, which may reveal additional aggravating or mitigating factors that justify a departure from the guidelines. Any Fellow for whom a hearing has been scheduled to consider revocation or suspension of Certification is offered the opportunity to return the Certificate in lieu of a hearing.
For purposes of ABCO discipline or denial of certification, with respect to licensing, "restricted" relates only to adverse actions, discipline, or limitations on practice arising from a state board discplinary action, and not to restrictions based on generally applicable limitations on scope of practice.
II. Options for Discipline
General Guidance: The ABCO has adopted the following measures as available remedies in cases it reviews:
* Probation of Certificate
* Revocation of Certificate
* Suspension of Certificate
* Letter of Concern/Reprimand
* Requests for Additional Information
* No action
ABCO Rules also give the Board the authority to impose other measures, such as placing conditions on maintaining one’s Certification.
III. Revocation or Suspension of State License – Practice Related
General Guidance: In cases where a Fellow’s state medical license has been revoked or suspended for practice-related reasons, the ABCO will typically take the same action against the Certificate. In other words, if a Fellow’s license has been revoked, the ABCO usually will revoke Certification. If the license has been suspended, the ABCO will suspend Certification co-terminus with licensure suspension.
In deciding what action to take, the Board will focus on the substance of the state action, rather than the state’s characterization since different states use different phrases to describe their actions. For the purpose of these guidelines, “revocation” means that the Fellow may no longer practice optometry in the state either permanently or indefinitely. “Suspension” means that the Fellow may not practice for some period of time and/or until the Fellow has complied with certain conditions. Voluntary or involuntary surrender of a license is equivalent to "revocation".
"Practice-related" means that the state licensure action is based on conduct related to the Fellow’s professional practice. This includes but is not limited to curtailment of hospital privileges, inability to practice safely due to physical or mental disability or substance abuse, inappropriate prescribing of medications, incompetence, insurance or billing fraud, medical record documentation issues, misinformation on licensure, credentialing, or certification applications, negligence, providing false or inappropriate expert witness testimony, and/or unprofessional conduct.
Revocation of a Certificate is permanent. Although former Fellows whose Certificates have been revoked may petition the ABCO to become certified again, those petitions more often than not be denied. Approval typically will be granted only in cases where the Board concludes that:
1. In retrospect lifetime revocation has proved to be disproportionate to the Fellow’s offense, and
2. The Fellow has taken steps to maintain or substantially improve the level of his or her knowledge and skills.
Suspension of a Certificate means that during the period of suspension an individual may not hold him or herself out to the public (patients, providers, and/or insurers, etc.) as certified by the ABCO. A Fellow violating this prohibition shall be subject to additional sanctions. Depending on the degree of the individual’s culpability, these will typically mean an extension of the period of suspension or revocation of the Certificate. Suspension typically will remain in effect for the period of suspension of the Fellow’s state license.
When a license is fully restored, the Fellow may apply for reinstatement of Certification. Such applications typically will be approved; however, the ABCO may deny an application or impose conditions on approval where appropriate, for instance when the length of the suspension raises concerns about the individual’s current knowledge and skills.
Appeals of State Action: When a Fellow is appealing revocation or suspension of his or her license, the ABCO decision to act will typically depend on the status of the license during the appeal. Notwithstanding, the Board will not allow a Fellow to stall its action simply by appealing state licensure decisions, particularly since such appeals can take several years to resolve. In cases where the license revocation or suspension is stayed during the time of an appeal (typically indicating that a court or panel has found some preliminary merit to the Fellow’s challenge), the ABCO will usually not pursue disciplinary action until the appeal is complete or the stay been lifted. Fellows must keep the Board apprised of all significant developments in litigation.
Exception to General Guidance – Fellow Retirement: In some cases, a Fellow may have retired either prior to or in connection with a state action against his or her license. In those situations, the ABCO will generally give the Fellow the option of retaining his or her Certificate (thus avoiding a hearing) so long as the Fellow signs a form certifying that he or she is permanently retired from the practice of optometry and agrees to other conditions imposed. This option typically will be offered in cases involving Fellows who:
1. Are 60 years of age or older,
2. Have a physical or mental disability that appears to make it impossible to continue the practice of optometry; and
3. Offer facts based on material in the Board’s possession suggest that the individual has likely retired.
Fellows who accept will be listed by the Board as “Certified – Retired”. The option may not be offered in cases where the misconduct of the retiring Fellow appears to have been willful and/or egregious, or in cases where the Fellow continues to hold an ownership interest in an optometric practice.
Actions in States Where Fellows No Longer Practice: Many Fellows carry licenses in multiple states, including some where they no longer practice. A Fellow may have active and unrestricted licenses in all states where he or she practices, while licenses in other states may have been revoked or suspended for practice-related issues. This occurs, for example, when a Fellow leaves a state where he or she got into trouble in order to get a fresh start elsewhere. It also may be the result of the Fellow practicing in a state that has more lax enforcement standards than a state where he or she maintains a license but does not actively practice.
In general, the Board will track the actions of the state(s) where the Fellow actively practices. Thus, so long as current, active, unrestricted licenses are maintained in each state where he or she actively practices, the ABCO typically will not suspend or revoke Certification. The Board reasons that the state where the Fellow actively practices has primary responsibility for monitoring conduct. To the extent that all of the Fellow’s active license states have determined that history and conduct support a full, unrestricted license, the ABCO will generally defer to the decisions of those states. Nonetheless, the ABCO may deviate when, for example, a Fellow appears to have been in trouble in several states over the years and continuously changed locations in order to avoid sanction.
IV. Revocation or Suspension of State License – Non-Practice Related
General Guidance: Where a Fellow’s state optometry license has been revoked or suspended for non-practice related issues, the ABCO will typically send a letter of reprimand or concern, or take no action. Non-practice related issues are unrelated to a Fellow’s practice as an optometrist, for example failure to pay taxes or renewal or related fines, and criminal convictions unrelated to the practice of optometry.
Although the Board typically will not suspend or revoke a Certificate for non-practice related issues, a Fellow who has his or her license suspended or revoked for non-practice related issues by a state where he or she actively practices will not be able to successfully complete the MOC cycle. Consequently, his or her Certificate will not be renewed at the end of the cycle.
V. Other State License Actions - Probation, Monitoring, Reprimand, and Censure
General Guidance: States often take actions against licenses that are less severe than revocation or suspension. Such actions include but are not limited to probation, monitoring, reprimand, and censure. In those cases, the ABCO will typically send a letter of reprimand or concern, or take no action, but reserves all rights, in its discretion, to take any other action the Board deems appropriate..
Exceptions include but are not limited to situations were the state-imposed monitoring or probation conditions are so significant as to constitute a substantial restriction on the Fellow’s practice of optometry. In those instances, the ABCO may consider suspension of Certification, which will typically be co-terminus with the period of probation or monitoring.
Although the ABCO may choose to not suspend or revoke a Certificate in cases involving these lesser sanctions, a Fellow who becomes subject to probation or monitoring in a state where he or she actively practices will not be able to successfully complete the MOC cycle. Once again, his or her Certificate will not be renewed at the end of the cycle.
VI. Disciplinary Measures Not Based on State Licensure
ABCO rules permit but do not require the Board to take disciplinary action in cases that are based on actions other than restrictions on a Fellow’s license. Such other grounds include but are not limited to violation of ABCO Rules and Regulations, exclusion from Medicare, Medicaid, or another third party payer, and serious professional misconduct.
General Guidance: These cases tend to be rare and also distinct from one another. Even the most general of guidelines have limited use.
For cases involving professional misconduct, the ABCO will tend to track the actions of state licensing boards since it does not have the resources to investigate and pursue every allegation of professional misconduct and instance of discipline by a hospital, managed care panel, or other third party. In cases where an allegation has risen to the level where a state takes action, the ABCO will typically also take action pursuant to the guidelines above. By contrast, in cases where the alleged misconduct has not risen to that level, the ABCO will defer to the state and either send a letter of concern or reprimand, or take no action.
Where a Fellow has been excluded from participation in Medicare, Medicaid, a third party payer, or his or her DEA license been suspended or revoked, a state almost always will take corresponding action against the optometry license. In those cases, the ABCO again will track the state’s action. In rare case where there is no corresponding state action, the ABCO reserves the discretion to track the Medicare/Medicaid/Third Party/DEA action. For example, if a Fellow is excluded from Medicare/Medicaid for a specified period of time, the Fellow’s Certificate typically will be suspended for a co-terminus period of exclusion. If a Fellow has been excluded from Medicare/Medicaid permanently or indefinitely, the Certificate will be revoked. Recognizing that different third party payers apply different rules and standards, the ABCO will, however, review each of these cases individually and decide to impose or not impose discipline based on the particular facts and circumstances leading to the underlying sanction.
Where a Fellow or candidate for Certification has violated ABCO rules, the discipline will depend on the seriousness of the violation. The most serious infractions include but are no limited to intentionally compromising the integrity of the ABCO or any of its certification procedures (for instance reproducing and/or disseminating materials not generally available to the public), knowingly providing misinformation on an application for certification or MOC, and failing to comply with the terms of a disciplinary measure imposed by the Board (for example, continuing to advertise oneself ABCO Certified during a period of suspension). In those situations, the Board will typically suspend or revoke a Certificate. In the case of a candidate who is not yet certified, he or she will be prohibited from becoming certified for either some period of time or permanently. Lesser infractions include but are not limited to unintentional nonmaterial misinformation on an application form, failure to notify the Board of changes of address, and failure to respond to requests for routine information. These may result in a letter of concern/warning or no action, unless the violations are repeated.
This guidance does not apply to candidates or Fellows who miss ABCO deadlines or fail to meet the substantive requirements for initial Certification or MOC. Those situations are not considered Rules violations. Normally, candidates or Fellows who miss deadlines or fail to meet requirements will be ineligible for Certification or MOC unless they have obtained an exemption or exception to the deadlines or requirements.