The Biennium That Slipped
Dr. B has practiced in Omaha for 12 years. Her Nebraska license expired on March 1. The office manager says a renewal notice went to an old email address, and Dr. B did not discover the lapse until 18 days later. In that period she saw 62 patients, ordered diagnostic tests, and wrote 9 prescriptions. She immediately stops seeing patients and submits a renewal application. Her CE file contains 28 hours: 14 from a Board-approved live conference, 8 from a Board-approved online course, and 6 from a 'practice management and billing' webinar that is not Board-approved. The renewal form asks her to attest that she completed 'all required continuing education.' Dr. B asks whether she can sign the attestation because she is 'only 4 hours short' and will make them up next month.
1. What are the consequences of practicing during the 18-day lapse, and does Nebraska have a grace period?
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Nebraska does not give a license holder a grace period to practice after expiration. Once the license lapsed, Dr. B was not authorized to examine patients, order diagnostic tests, or write prescriptions. Each of the 62 encounters and each prescription may be treated as a separate violation, and the Board can pursue discipline for unlicensed practice even if Dr. B did not intend to violate the law. 'I did not receive the notice' is not a defense; the licensee is responsible for maintaining a current address and renewing on time. She should not see another patient until the license is active. She should also review billing and insurance claims submitted during the lapse, because those services may be non-reimbursable and may require disclosure or repayment. Prompt self-reporting and immediate cessation are mitigating facts, but they do not erase the violation.
2. How should Dr. B handle the CE shortfall and the attestation?
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She must not sign the attestation. The Board's rule requires 32 approved hours for the biennium, and she has only 28. The 6-hour billing webinar is not Board-approved, so it cannot count merely because it is continuing education in a broad sense. She needs at least 4 additional approved hours, and she should confirm whether any category-specific hours are also required. Signing a false attestation would be a separate integrity violation and would undermine any claim of good-faith correction. The proper course is to complete the missing approved hours, document them, and then submit an accurate renewal application with a written explanation of the lapse and the CE deficiency. She should ask the Board whether late completion is acceptable, but she should not assume that retroactive approval will be granted.
3. What should the Board consider in deciding discipline, and what remedial steps would mitigate the violation?
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The Board should weigh the length of the lapse, the number of patients seen, whether any patient was harmed, whether prescriptions were clinically appropriate, whether insurance claims were submitted, and whether the OD self-reported and cooperated. It should also consider prior discipline and the accuracy of the renewal application. Mitigation includes immediate cessation of practice, prompt self-report, correction of the CE deficiency, an audit of charts and claims, and a plan to prevent recurrence such as calendar reminders and address updates. The Board may impose a civil penalty, censure, probation, additional CE, or other conditions. Due process requires notice of the charges and an opportunity to respond. The absence of patient harm is relevant but does not eliminate the unlicensed-practice violation.