Eleven Weeks Unlicensed: Renewal Lapse, CE Deficiencies, and a Payer Audit

Administrative (license discipline). Practicing optometry on an expired license violates the licensure requirement of Article 15 of the Public Health Code; a lapsed license is not a license, and there is no grace period. Refilling latanoprost by telephone during the lapse is the same violation in a different form, plus it is prescribing without authority. Failing to keep a current address of record with the department is a separate rule violation and is the reason the renewal notice never arrived, which is an explanation but not a defense. Grounds would fall under MCL 333.16221, which reaches violations of the article and its rules, fraud or deceit, and negligence or incompetence.

Potential criminal. Unlicensed practice under MCL 333.16294 is enforceable by the department through investigation and cease-and-desist authority, and the unlicensed-practice provisions carry misdemeanor exposure. That is a real risk where a patient encounter, a prescription, and a filled order can all be documented.

Civil and payer. Sixty claims submitted for services rendered by an unlicensed provider are claims for services that were not covered as billed. That is a self-audit-and-repay problem, may be a false-claims problem depending on the payer and the knowledge element, and can trigger network termination and referral to a fraud unit. Each payer has its own disclosure obligation and timeline, and the practice should not wait for the audit to conclude.

The instinct to backdate is the worst item on the list. Altering a renewal form to show a false date or attesting to CE that was not completed converts a fixable lapse into fraud, which is far harder to defend and far more likely to end in suspension.

Sequence matters, because each step creates a record the next step will be judged against.

1. Stop practicing immediately. Every additional patient encounter is another violation and another claim to unwind.
2. Notify the employer in writing and have the practice suspend her schedule and privileges. The credentialing coordinator already knows; delay looks like concealment.
3. Update the address of record so future correspondence reaches her.
4. Determine the correct application type. A license that has been expired for a short period is typically renewed with the renewal fee, any late fee, and proof of the CE required for the period. A license expired for an extended period, generally three years or more, requires relicensure and satisfaction of the requirements in effect at the time of application, which may include examination. Confirm the current form, fees, and lapse threshold with the Board of Optometry before filing.
5. File truthfully. Attest only to hours actually completed and documented. If hours are missing, complete approved hours first, or request the extension or waiver available for good cause through the department's CE process.
6. Decide on disclosure deliberately, with counsel. The application may ask about practice during a lapsed period; answer accurately. Counsel can also advise on whether to submit a self-report to the Bureau of Professional Licensing before a patient or payer complaint arrives, which generally reads better than being discovered.
7. Run the payer self-audit and repay in parallel, with a written compliance plan.

Reinstatement is a paperwork problem. Backdating is a discipline problem. She should not trade the first for the second.

Apply the Board of Optometry's current CE rule to the total and to each category, and note that the rule, not the licensee's memory, controls.

• 6 hours of practice marketing. Practice management and marketing content is typically capped, and often excluded outright, because it is not optometric education. Expect zero or a heavily discounted fraction.
• 4 hours of CPR and first aid. CPR certification is a clinical safety credential, but it is usually not board-approved optometric continuing education and generally does not count toward the optometric total. Verify, because some boards allow a small allowance.
• 4 hours of board-approved glaucoma lectures. These count cleanly.
• 4 hours of article-based self-study with no sponsor documentation. The content might qualify, but the burden is on the licensee to prove sponsorship, accreditation, date, and hours. Without a certificate or sponsor record, a board auditor will disallow it.

So realistically she has 4 confirmed hours of a substantially larger requirement, and possibly 8 if the self-study can be documented after the fact by obtaining duplicate certificates from the sponsor.

Options if the hours cannot be completed in time:

1. Complete approved hours now, before filing, and document each with certificates retained for audit.
2. Ask the department for the extension or waiver available for good cause. "I moved and did not open my mail" is weak; a documented illness or catastrophic event is stronger, and the request must be honest about the cause.
3. Do not attest to completion that is untrue. A false CE attestation is independently disciplinable, and CE audits are routine, so the odds of being caught are not small.

Keep certificates for at least the audit retention period, and note that after any disciplinary order, additional CE is commonly imposed as a sanction condition.