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12 Tips on Protecting Your Rights and Defending Yourself Against Irregular Behavior Charges from the USMLE

Attorney George F. Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

If you are one of those unlucky individuals who have been accused of irregular behavior by the United States Medical Licensing Examination (USMLE) Secretariat, then it is extremely important for you to know this information.

USMLE hearings on irregular behavior are almost always held in Philadelphia, Pennsylvania, before a large committee the committee on individual review or “CIR,” appointed to hear such cases. The committee is composed of medical school professors, doctors, medical school administrators, members of various medical specialty associations, and others. The hearings are held in one of the conference rooms of the National Board of Medical Examiners (NBME) Building in Philadelphia.

We routinely represent medical students and graduates who have taken the USMLE Step exams and have later been accused of irregular behavior. This includes hearings, appeals and other legal matters involving the Step Exams, credentials, responding to inquiries about the misconduct of school officials and related matters.

What is Irregular Behavior?

Irregular behavior can include many different types of action. We have seen cases in which someone set the test center building on fire in order to have the test (which was ongoing) canceled with irregular behavior because they wrote on their hand or their arm or ankle during the examination. We have seen individuals charged with irregular behavior because they had handwriting on the bottom of a flip flop or a sheet of toilet paper; we have seen individuals charged with irregular behavior because they used their iPhone during a break or they were not still in medical school on the day the Step exam was given. We have seen those charged with irregular behavior for altering their test scores on their test transcripts, even though they received a passing grade and because they posted “Me too” on a website where someone had asked if anyone had copies of “The Houston Cases” or wanted them.

We have seen those charged with irregular behavior because they posted information on an Internet website that the USMLE thought was too similar to actual test materials. We have seen individuals charged because they used forged documents to obtain access to the test or to apply to monitor’s instructions at the test center. We have seen individuals charged with irregular behavior for sending forged test scores to their medical school. We have seen applicants charged with irregular behavior for not following the monitor’s directions at the test center. We have represented test-takers who were accused of irregular behavior because their test answers were too “statistically similar” to those of another test taker who took the test at a different location and date.

We have represented medical students charged with irregular behavior because they had completed their USMLE applications incorrectly, using the information that their medical school officials had told them to place on the forms. We have represented medical school students charged with irregular behavior because their medical schools had placed the wrong information on their cation forms (note: later the medical school itself was found to have been guilty of irregular behavior by the organization.)

However, allegations of irregular behavior can usually be easily overcome with an explanation of the truth. It is up to you (and us, if you hire us) to present the truth as to what really happened and why it happened.

Although it is our best advice that you retain the services of an experienced health lawyer, specifically one experienced in dealing with the USMLE and in representing applicants in USMLEor

Tips for Preparing for a Hearing Before the Committee on Individual Review of the USMLE.

Following are several of the most important tips we can present on how to best prepare for a hearing before the Committee on Individual Review of charges of Irregular Behavior.

1. Be sure to request a complete copy of the USMLE’s file and work case, including any investigation, incident reports, videos, or other materials, before you file a response, in writing.

2. Be sure that you file your statement, explanation, or other appropriate documents (depending on the facts and circumstances of your case) prior to the deadline given in the initial letter to you. Document its transmission to and receipt by the USMLE.

3. If you need an extension of time, request this in writing prior to the expiration of the deadline given to you in the original letter. Do this in writing and keep a copy.

4. Be sure that you request in writing a hearing and to appear in person at the hearing prior to the deadline given in the initial letter to you. (Note: if are already going to appear at the same hearing meeting, we can give you a discount from our normal legal fees for this representation. Ask about this.)

5. If you are unable to appear in person at the hearing in Philadelphia, Pennsylvania, on the date provided in the initial letter, ask that your hearing be postponed until the next available date, and provide good, sufficient reasons why you are unable to attend on the original date given.

6. Be very careful and deliberate about what you state in writing. Any statement you make should be well-organized, professionally prepared, and supported by adequate, relevant, affidavits and documents. This is another reason why you should have an attorney preparing and submitting this for you.

7. In some cases, we recommend hiring an expert to review the case and provide us an expert affidavit to submit. This may be the case when confronted with charges based on statistical analysis, computer systems issue, testing procedures, questionable documents, or other technical matters.

8. Your statement and presentation should directly address the allegations made against you. You are strongly encouraged to review the blog I previously wrote on preparing professional correspondence here.

9. Never lie or submit any false information or documents. The USMLE will thoroughly investigate any suspicious or questionable facts or materials you submit. This can extend to the use of private investigators to locate and interview witnesses, forged documents, or questioned document examiners to analyze documents submitted, and other such methods. Submitting any false information can lead to vastly more severe actions against you.

10. Get prepared for your hearing. Think about and rehearse what you will say. You will be under a lot of stress, in front of about 20 people, most of whom will be asking questions to you. If you are not ready for this, it will be to your detriment.

11. Expect the usual questions. But then, also expect the unusual questions that you may be asked. Plan for what questions may be asked by the Committee members. We always prepare our clients to testify and to be prepared to answer various questions that we know are likely to be asked.

12. Remember that you will be in an unusual, stressful, situation, one which you have probably never experienced before. Plan for this. Obtain as much information about the situation as you can. If you are not used to attending contentious hearings and being cross-examined and interrogated (which 99.9% of doctors are not), then you need to have an experienced attorney sitting next to you.

These are important matters that will affect your future career as a physician. Consider how much in time you have spent and how much in tuition, fees and student loans you have incurred to get this far. Is it smart to scrimp at this point in time and take the cheap way out by either trying to represent yourself or finding a cheap, inexperienced attorney to represent you?

Click here to read one of my prior blogs on the consequences of irregular behavior.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Irregular behavior defense lawyer, irregular conduct legal representation, graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

ECFMG Hearing on Irregular Behavior? Tips on Protecting Your Rights and Preparing

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

If you are one of those unlucky individuals who have been accused of irregular behavior by the Educational Commission for Foreign Medical Graduates (ECFMG), then it is extremely important for you to know this information.

ECFMG hearings on irregular behavior are almost always held in Philadelphia, Pennsylvania before a large committee appointed to hear such cases. The committee is composed of doctors, medical school administrators, members of various medical specialty associations, and others. The hearings are usually held in a conference room of a large hotel, in closed session (not open to the public).

Since live witnesses (other than yourself) are not permitted, it is very important that any witness testimony of any kind be reduced to writing, preferably in the form of an affidavit, and submitted prior to the deadline you are provided.

Although it is our best advice that you retain the services of an experienced health lawyer, specifically one experienced in dealing with the ECFMG and in representing applicants in ECFMG hearings on irregular behavior, below we have listed helpful tips we have gathered through our years of experience.

The following are some tips to assist in ensuring your rights are protected.

1. Be sure to request a complete copy of the ECFMG’s file and work case, including any investigation, incident reports, videos, or other materials, before you file a response.

2. Be sure that you file your statement, explanation, or other appropriate documents (depending on the facts and circumstances of your case) prior to the deadline given in the initial letter to you. Document its transition and receipt.

3. If you need an extension of time, request this in writing prior to the expiration of the deadline given to you in the original letter. Do this in writing and keep a copy.

4. Be sure that you request in writing a hearing and to appear in person at the hearing prior to the deadline given in the initial letter to you.

5. If you are unable to appear in person at the hearing in Philadelphia, Pennsylvania, on the date provided in the initial letter, ask that your hearing be postponed until the next available date, and provide good, sufficient reasons why you are unable to attend on the original date given.

6. Be very careful and deliberate about what you state in writing. Any statement you make should be well-organized, professionally prepared, and supported by adequate, relevant, affidavits and documents. This is another reason why you should have an attorney preparing and submitting this for you.

7. In some cases, we recommend hiring an expert to review the case and provide us an expert affidavit to submit. This may be the case when confronted with charges based on statistical analysis, computer systems issue, testing procedures, questionable documents, or other technical matters.

8. Your statement and presentation should directly address the allegations made against you. You are strongly encouraged to review the blog I previously wrote on preparing professional correspondence.

9. Never lie or submit any false information or documents. The ECFMG will thoroughly investigate any suspicious or questionable facts or materials you submit. This can extend to the use of private investigators to locate and interview witnesses, the use of questioned document examiners to analyze documents submitted, and other such methods.

10. Get prepared for your hearing. Think about and rehearse what you will say. You will be under a lot of stress, in front of about 20 people, most of whom will be asking questions to you. If you are not ready for this, it will be to your detriment.

11. Expect the usual questions. But then, also expect the unusual questions that you may be asked. Plan for what questions may be asked by the Committee members. We always prepare our clients to testify and to be prepared to answer various questions that we know are likely to be asked.

12. Remember that you will be in an alien situation, one which you have probably never experienced before. Plan for this. Obtain as much information about the situation as you can. If you are not used to attending contentious hearings and being cross-examined and interrogated (which 99.9% of doctors are not), then you need to have an experienced attorney sitting next to you.

These are important matters that will affect your future career as a physician. Consider how much time you have spent and how much in tuition, fees and student loans you have incurred to get this far. Is it smart to scrimp at this point in time and take the cheap way out by either trying to represent yourself or finding a cheap, inexperienced attorney to represent you?

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board of Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat, and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Irregular behavior defense lawyer, irregular conduct legal representation, graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

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Here Are Some Common Sense Tips for Taking Your USMLE Step Exams and Scoring Higher

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Here are some common-sense tips you should be sure you follow that may help you to reduce stress and score higher when you take your United States Medical Licensing Examination (USMLE) Step examinations. You should be doing everything within your control to minimize your stress and the risk of being late for the examination. Again, these are common sense and if you have taken a lot of standardized examinations, you may already be aware of these.

1. Do not plan on driving to the test site from your home the morning of the examination even if you leave in the same city as the testing center.

a. Unexpected car problems could occur.
b. Traffic backups and delays always occur.
c. Accidents always happen.
d. Road problems, construction delays, and detours are common.

Eliminate these unnecessary risks.

2. Find the hotel closest to the testing center and stay there the night before the test. Hopefully, this will be within walking distance of the test site if it is necessary to walk there.

3. Read all of the applicable testing procedures, the applicable USMLE and/or Educational Commission for Foreign Medical Graduates ( ECFMG) Handbook, Guidelines and Procedures again the day before the examination you are taking. You signed an agreement to be bound by these and you are expected to know these for the examination. Be sure you understand how scheduled and unscheduled breaks work, how the time is accounted and what you are allowed to do and prohibited from doing on breaks.

4. Make sure you know ahead of time exactly how much time you will be given for each part of the examination and for breaks, Be sure you have calculated how much time you have for each question on each section of the examination, answer within the times you have calculated and move on through the examination in a timely manner.

5. Do not let other occurrences and disturbances in the testing center upset you or distract you.

6. If some extremely disruptive event occurs, for example, fire alarms and evacuations taking place, other examination takers having seizures and being removed by paramedics, etc., consider leaving and taking an incomplete on this examination. Be sure to ask the test center monitors/proctors to file an incident report on what occurred at the test center, Then, within 24 hours, write to the USMLE and ECFMG and advise the organization of exactly what happened and why you had to leave.

7. Bring your own lunch, snacks, and beverages, including something like energy bars or chocolate bars, to provide needed sustenance. Do not leave the testing center for lunch unless you absolutely have to, and then, stay local and on foot. Do not take the risk of driving someplace and back.

8. If a certain testing center has a bad reputation for being a poor testing site or having frequent computer failures, schedule to take the test at a site in another city or state. Travel there and stay at a hotel within walking distance of the test site, perhaps a few days before the examination date. You can then use the additional time and isolation for additional studying and test preparation.

9. Do not refer to or use any cell phone, tablet or personal device while the test is still underway. Be sure you are familiar with all test-taking procedures.

10. To avoid any risks of misunderstandings, do not write down anything during the examination or about the examination at the testing center. Outside during lunch, may be okay; otherwise, wait till you get back home.

Although common sense, you would be surprised at how many test-takers violate these common-sense tips and then suffer from the consequences.

Plan for and have as stress-free of an examination as you can. Control the controllable.

For more helpful tips and to learn more about examples of “Irregular Behavior,” click here to read my prior blog.

Additionally, click here to view one of our blogs on our experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education, and those being challenged by the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG)

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters. We routinely help those who have disputes with the National Board fo Medical Examiners (NBME), the United States Medical Licensing Examination (USMLE) Secretariat , and the Educational Commission for Foreign Medical Graduates (ECFMG), including on hearings and appeals concerning “Irregular Behavior,” “unprofessionalism,” and “Irregular Conduct.”

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Irregular behavior defense lawyer, irregular conduct legal representation, graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Many Actions Can Result in Allegations of Irregular Behavior or Irregular Conduct

George Indest headshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

I have written many blogs in the past, on allegations of irregular behavior being brought against medical students, foreign medical graduates and others applying to take examinations to qualify for a medical license in the United States. These have previously focused on charges made by the United States Medical Licensing Examination (USMLE) Secretariat (an affiliate of the National Board of Medical Examiners (NBME)) and the Educational Commission for Foreign Medical Graduates (ECFMG). In this blog, I will discuss similar allegations made by the National Osteopathic Board of Medical Examiners (NBOME) and the types of actions that are considered “irregular conduct.”

To read several of my prior blogs on these topics, click here to read one on common mistakes made on the USMLE exam or click here to read one on what to do if you receive an inquiry from the USMLE, ECFMG, or NBME.

Charges of “Irregular Behavior” or “Irregular Conduct” Are Similar No Matter What Organization Made Them.

The NBOME is the organization that confirms credentials, tests and regulates osteopathic physicians applying for licenses in the United States.

Like the other organizations mentioned above, it has certain types of conduct (or misconduct) it prohibits that can result in adverse actions being taken against the applicant. The USMLE and the ECFMG refer to these as “Irregular Behavior.” The NBOME refers to these as “Irregular Conduct.” They include, for example, actions that could be termed “cheating” or attempting to gain an unfair advantage on an examination or providing false information on an application.

Irregular Conduct: Definition.

The NBOME defines the term “Irregular Conduct” to include:

any behavior on the part of any candidate [applicant] that violates the integrity or security of the examination, behavior that is disruptive to administration of the examination, or behavior deemed by the NBOME in its sole discretion to be inappropriate in connection with the application, registration, taking, administration, integrity, and security of any NBOME examination.

The key part to this definition is that the NBOME reserves the right to make such determinations “in its sole discretion,” which is a subjective standard that is usually not subject to being second-guessed by a court or other agency.

Examples of “Irregular Conduct.”

The Bulletin of the NBOME provides the following as examples of Irregular Conduct:

1. Copying, fraud, deceit, or other dishonest conduct.

2. Refusal to provide a proper ID or permit photo documentation or other identification for ID verification at any time. Providing false or forged identification upon presentation for testing at a test center. It should be noted that this is to ensure the test-taker is the correct individual and that a “ringer” is not being used.

3. Communication or attempts to communicate with others during the examination other than authorized test center professional staff.

4. Removal of or attempts to remove any test material, scrap paper, or whiteboard from the assigned test area. These organizations are very serious about protecting the integrity of the examination questions and answers, so they go overboard to protect them.

5. Non-compliance with test center rules and regulations and security requirements, including operating test center equipment without reasonable care. This is self-explanatory.

6. Providing or receiving unauthorized information about the content of an examination. We have seen numerous cases of this occurring (or at least being charged against applicants) as a result in participation in Internet listervs and forums on these examinations. Even asking for “cases,” “questions,” or “subjects” from an examination may result in an allegation of irregular conduct.

7. Violation of the NBOME’s non-disclosure or confidentiality policies or the candidate’s non-disclosure agreement.

8. Communication or attempts to communicate about the content, format, or specific test items with another candidate or with any outside source or party (including use of telephones, personal computers, internet access, test review companies, or any other means) at any time, either before, during, or after an examination. See the comments directly above. Posting, downloading or requesting such materials from others has been charged as irregular conduct.

9. Using or having available or access to any unauthorized device, text, notes, or other material that could assist the candidate in taking the examination. Bringing personal property into the test area is considered by the NBOME to violate the security of the examination. This would include, for example, an iPad, smartphone, smartwatch or other types of electronic devices that can access the Internet or notes, “crib sheets,” outlines, or any other type of written assistance.

10. Providing false admittance information or altering applications, score reports, transcripts, or certificates. We have seen an example where an applicant who passed an examination altered his test report to show a higher grade. He was caught, as is usually the case, and received an adverse finding and this was noted on his permanent record with the testing organization.

11. Disrupting another candidate or candidates. This can include, for example, pulling a fire alarm during an examination, setting a fire in the building where the examination is being administered, talking to someone else or any type of noisy or disruptive conduct.

12. At any time (i.e., before, during, or after any examination) verbally or physically harming or threatening to harm the test center professional staff, other examinees, test center employees, or NBOME personnel, representatives or agents, including telephone and in-person encounters regarding scheduling, scores, or score reporting. Although we have never heard of actual cases of most of these types of conduct, we understand that sometimes angry applicants have threatened staff members and personnel. Therefore, one should always be courteous and respectful in all dealings with test center and NBOME staff and personnel.

13. “Unprofessional Conduct” which we will discuss in Part 2 of this blog.

14. Other behavior deemed by the NBOME to be unethical or unprofessional. This is, of course, a “catch-all” provision that allows the NBOME to charge an applicant with just about anything that it believes is irregular conduct.

Unprofessional Conduct and Actions that NBOME can Take.

In Parts 2 and 3 of this blog, I will discuss what the NBOME deems to be “unprofessional conduct” as well as the actions it may take and procedures that apply to an applicant facing such allegations.

Stay tuned for part 2 and part 3!

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and the NBME.

To learn more, read two of my prior helpful blogs here titled, “Medical Students, Interns & Residents Beware: A Finding of “Irregular Behavior” Can Ruin Your Medical Career Before it Starts,” and  “USMLE Hearing? Organization, Timing, and Evidence are Crucial.”

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Cheating, Irregular Behavior and Other Challenges Facing Medical Students and Graduates

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The road to becoming a physician is paved with many unique challenges. The long, exhausting journey begins and students are faced with the first battle: rigorous undergraduate course work, followed by the MCAT and medical school applications. During medical school, and for some, after graduation, the USMLE (United States Medical Licensing Examination) and its STEP 1, STEP 2 and STEP 3 exams provide another hurdle in the uphill battle. At any of these stages, medical students can face a gauntlet of accusations including cheating, misrepresentation, falsification of information, unfair advantages and the many faces under the general label of “irregular behavior.”

Challenges Prior to Entering Medical School.

Prior to medical school, pre-med students must be ambitious, inquisitive and extra cautious about any disciplinary action. A minor blemish on a pre-med student’s academic record (from academic dishonesty or other accusations), will become a major red flag once that student begins applying. Not only will any kind of discipline record hinder a student’s chances of acceptance, an infraction can also ruin that student’s reputation as they apply for residency and beyond.

Because the process of becoming a physician is difficult without having a discipline record, any charge against a pre-med student must be taken with the upmost seriousness. Don’t raise a white flag early on in the uphill battle!

Challenges After Medical School.

The battle continues for medical students; medical school courses and clinical rotations will be rigorous and challenging, calling on every neuron you possess to fire efficiently. You will be tested, in more ways than one. You will forget the term “MCAT” and substitute for it a new acronym–“USMLE” which stands for United States Medical Licensing Examination.

The USMLE is a four stage examination required for medical licensure in the United States. Because the USMLE is the barrier between you and your medical license, it is an extremely important component of your medical education.

One such issue is being accused of “irregular behavior.” This broad label includes anything from cheating to disruptions during testing or soliciting information on actual examination content. In the event that your test score is held up or invalidated due to irregular behavior you will want to correct the situation immediately, or you may be prohibited from taking future exams (meaning you won’t be able to obtain your license or a residency in the U.S.). If you are accused of irregular behavior or if you feel that you were faced with inadequate testing conditions, resolving the issue may be as simple as requesting a rescoring of the examination or a retest. Sometimes, because of problems at a test site or because of technical problems, retesting is an option.

The National Board of Medical Examiners and the USMLE take all such matters concerning the administration and the security of the test contents extremely seriously. In ceratin cases, they have sued those they believe may have compromised actual test contents. Click here to read more about the case.

After years of schooling, don’t allow an allegation of irregular behavior to mark your test transcripts and prevent you from attaining your goals and reaping the benefits of your hard work.

To learn more about USMLE, irregular behavior and how we can help you, click here to read one of my prior blogs.  Check our Medical Education Law Blog Regularly to stay on top of news and tips!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2019 The Health Law Firm. All rights reserved.

Medical Resident Awarded More Than $400,000 in Hospital Breach of Contract Lawsuit

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On October 9, 2018, a jury in Michigan federal court awarded more than $400,000 to the parents of an international medical school graduate after finding that Pontiac General Hospital breached their son’s residency program contract. The law suit, which has been described as a “pay for play” case, was first filed in 2017 in the U.S. District Court in Detroit, Michigan.

Breach of Contract.

The Canadian family claims the owners of Pontiac General asked for $400,000 in exchange for their son’s acceptance into the facility’s residency program in the fall of 2016. Court records show that the medical graduate received a signed residency contract the same day his father paid the final of three checks. However, it is alleged that soon after paying the fee, the hospital breached the contract by declining to let him start the program, and to add insult to injury, the hospital refused to return the funds.

The eight member jury reached a unanimous verdict and the family was awarded a total of $484,000.

The attorneys of The Health Law Firm routinely represent medical students, resident physicians and fellowship physicians, in legal disputes with their medical schools, residency and fellowship programs, and with the United States Medical Licensing Examination (USMLE), National Board of Medical Examiners (NBME), Educational Commission for Foreign Medical Graduates (ECFMG), and legal representation and defense of charges of irregular behavior. This representation includes internal disciplinary and grievance hearings, administrative hearings, due process complaints, academic and conduct committee hearings, appeals, and civil litigation. Click here to learn more about how we can help you in situations like this.

Contact a Health Care Attorney that is Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

“Pontiac General Hospital ordered to pay over $400K to doctor in pay-to-play lawsuit.” WXYZ News Detroit. (October 9, 2018). Web.

Greene, Jay. “Family wins Pontiac General ‘pay-for-play’ residency case.” Modern Healthcare. (October 15, 2018). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute attorney, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing, legal representation for resident physicians and fellowship physicians, representation for legal disputes with medical schools, representation for residency and fellowship programs, National Board of Medical Examiners (NBME) attorney, Educational Commission for Foreign Medical Graduates (ECFMG) attorney, legal representation and defense of charges of irregular behavior, representation for internal disciplinary and grievance hearings, representation for administrative hearings, representation for due process complaints, academic and conduct committee hearings attorney, civil litigation attorney

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

By |2018-11-27T19:31:12+00:00November 27th, 2018|Categories: Medical Education Law Blog|Tags: , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |1 Comment

Have You Received a Letter from the ECFMG or USMLE Accusing You of Irregular Behavior? All Is Not Lost; Legal Advice Is as Close as a Phone Call Away!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Have you recently received a letter from the Educational Commission for Foreign Medical Graduates (ECFMG) or the United States Medical Licensing Examination (USMLE) Secretariat accusing you of “irregular behavior?” All is not lost. But you should seek advice from an attorney or law firm that has a lot of experience with such matters, before responding or doing anything else.

If You Are Innocent or Have a Believable Explanation to Justify What You Are Being Accused of Doing, You Need to Defend Yourself Against the Accusations of “Irregular Behavior.”

Yes, it is possible to successfully defend yourself against accusations of “irregular behavior.” However, we do not suggest that you should attempt to represent yourself or do this on your own. In any letter you receive on this will be advised of your rights to make a statement explaining your side, to have a hearing committee consider the matter, to appear in person before the hearing committee, and to have legal representation (an attorney) at the hearing with you to represent you. We recommend that you always ask for an exercise all of these rights.

It has been our experience that those individuals who think that they can just write a letter and explain what happened will usually not succeed. A full investigation has already been conducted by the USMLE or ECFMG and it will feel that it has already adequately explored and discovered all of the facts in your case.

It is our advice that you must always find out exactly what evidence or information the organization has against you and you must appear in person and testify under oath at a hearing at which the committee can ask you questions in order to show your honesty and innocence.

As Attorneys Experienced in Such Matters, We Know How to Prepare and Present Cases to Such Hearing Committees and to Successfully Convince Them of Your Position.

Our law firm and our attorneys have had a great deal of experience in dealing with the ECFMG and the USMLE on issues involving grading on the Step examinations, accusations of “irregular behavior,” testing and grading irregularities, and allegations regarding conduct which the organizations contends is “irregular behavior” (including mistakes in completing applications and affidavits). We haven’t represented many medical students and medical graduates in challenges, hearings before the committees, and on appeals.

Although, just as in medicine, in legal matters such as this one, we cannot guarantee any specific outcome or success in a case, we can advise you of our many successful cases. Finding any lawyer in the United States who has a great deal of prior experience with the USMLE or the ECFMG is very difficult. There are very, very few of us. Additionally, once you check out the backgrounds of any attorney whom you are considering, you may find that the particular attorney is not what you expect or would desire to hire. You want to hire attorneys that have a great deal of experience in this area, who know what they are doing, and who will not exaggerate or promise you that which they are not able to deliver.

Experience, Organization, and Knowledge are the Hallmarks of Our Legal Representation of You!

In our case, we tell the truth, we know what the “hot” issues are that are important to the ECFMG he and the USMLE, and we are aggressive advocates of your innocence or your position in the case. We prepare ahead of time and put together a comprehensive, detailed, and well organized presentation, through documents, which we deliver to the committee ahead of time for its consideration at your hearing. We always go to the hearing in Philadelphia, appearing with you in person at the hearing, and making the best presentation possible for you. We are by your side allo the way!

We do our best to prepare you ahead of time, going over potential questions that the committee might ask you and preparing your testimony in advance. We try not to leave anything to chance. If you are subject of a similar type of hearing, or court case, then you really do need experienced legal counsel to help you prepare. You should not try to do this alone.

Severe Consequences of Receiving a Label of “Irregular Behavior.”

There can be some very severe consequences of receiving a label of “irregular behavior,” if you do not adequately defend against such allegations. These can extend all the way from a stamp on the transcript of your Step examination scores stating “irregular behavior,” with a letter attached to it going into great detail about your “irregular behavior,” all the way to a complete ban (forever) from taking any further Step examinations, and everything in between. Even the stamp of “irregular behavior” alone can prevent you from successfully matching with residencies you are seeking or obtaining jobs you desire. This is similar to having a stamp of “Found Guilty of Cheating” on a transcript; the effect may be the same. You may find yourself being excluded from receiving interviews or invitations from residency program for which you apply.

Do not take a chance! Although legal representation may be expensive, you must consider the amount of time and money you have already spent to date to have a medical career and be willing to spend what it takes to continue that career. Don’t jeopardize it by trying to scrimp on legal fees. Remember that you usually get what you pay for.

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and he NBME. To review a few of these please see:
Limits on Number of Attempts and Time for Completion of USMLE Step Exams and
ECFMG Affidavit to Complete? Attending a Caribbean Medical School? Being Investigated for Irregular behavior by the ECFMG or USMLE? You need Legal Advice! Your Residency Matching Might Now Be at Issue, as Well!

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

ECFMG Affidavit to Complete? Attending a Caribbean Medical School? Being Investigated for Irregular behavior by the ECFMG or USMLE? You need Legal Advice! Your Residency Matching Might Now Be at Issue, as Well!

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

Have you recently unexpectedly received an affidavit from the Educational Commission for Foreign Medical Graduates (ECFMG or the United States Medical Licensing Examination (USMLE) Secretariat? Are you attending or have you graduated from a Caribbean medical School such as the University of Science, Art and Technology (USAT), Faculty of Medicine, in Montserrat, or the Atlantic University School of Medicine (AUSOM) in St. Lucia? Then you are probably, unknowingly, being investigated for misconduct, improprieties in your medical school attendance or other “irregular behavior.” You need to consult with a lawyer and specifically a lawyer who knows and understands the processes followed by the ECFMG and the USMLE.

Large Number of Legal Inquiries Being Received from Current Students and Graduates of USAT.

A year ago, our firm was receiving a large number of calls from students and graduates of the Atlantic University School of Medicine (AUSOM) concerning inquiries and letters they were receiving from the ECFMG and/or the USMLE. However, over the past several months, we have now received an even larger number of inquiries from students and alumni of the University of Arts, Technology and Sciences (USAT) Faculty of Medicine in Montserrat. We have now seen several different affidavits which the ECF image he has sent to students and graduates of USAT which request some very specific and detailed information about their course attendance and experience as students at USAT.

Each inquiry we have received from students and graduates of USAT has disclosed facts and circumstances that are slightly different from the other. From these we have been able to piece together a fairly comprehensive picture of what is probably going on. To summarize, it appears that you SAT is under investigation by the ECF image he for the various irregularities that our clients have disclosed have occurred in the past.

Affidavits from the ECFMG and the USMLE Should Be Taken Very Seriously. They Should Be Answered Truthfully and Must Be Returned Promptly.

The Handbook and Guidelines published by the ECFMG and the USMLE, require that any student or graduate who applies for their services must promptly respond to requests for information. This would include responding to the affidavits (which are really questionnaires to be completed under oath). Otherwise, the applicant can be charged by the ECFMG or the USMLE with “irregular behavior” in accordance with the Handbook and Guidelines that they previously agreed to follow when initially applying.

We hear from our callers, clients, and potential clients that they may have received instructions from their schools or from other sources that they do not have to do send these affidavits back in or respond to these requests for information. We do not believe that this is correct and vice. If confronted by having been sent such an inquiry or affidavit by the USEMLE or ECFMG, you should immediately contact competent, experienced, legal counsel to advise you on the exact issues and facts of the situation. You will only receive advice that takes your own personal interests into consideration from your own personal attorney; you are not likely to receive it from anyone else.

View Our Other Blogs on Our Experience with the USMLE, ECFMG, and NBME, and Hearings on “Irregular Behavior.”

Our law firm is had a great deal of experience representing students and graduates in disputes with and defending charges of “irregular behavior” against the USMLE, ECFMG and he NBME. To review a few of these please see:
What to Do If You Receive an Inquiry From the USMLE, ECFMG, or NBME
GOING TO TAKE THE USMLE STEP EXAMS? BEWARE OF ACTIONS THAT CAN BE CALLED “IRREGULAR BEHAVIOR”-PART 1, and
Accused of Irregular Behavior on the USMLE? Here’s What You Will Do Wrong.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

What to Do If You Receive an Inquiry From the USMLE, ECFMG, or NBME

By Achal A. Aggarwal, J.D., M.B.A., Attorney, The Health Law Firm

The National Board of Medical Examiners (NBME) is an organization that sets certain standards for anyone seeking licensure in the U.S. It prepares and administers state recognized examinations for medical students and medical residents, to assure they meet certain requirements for clinical knowledge (CK) and ability to interact effectively with patient using the English language, the latter know as “clinical skills” (CK). The NBME’s mission is centered on the assessment of physicians. The NBME develops and manages the United States Medical Licensing Examination (USMLE) through the USMLE Secretariat.

The USMLE is a multi-part professional examination sponsored by the NBME and the Federation of State Medical Boards (FSMB). In order to obtain a license to practice medicine or to participate in medical specialty residency programs in the U.S., one must take and successfully pass all four parts of the USMLE. Each part of the USMLE is referred to as a “step.”

Foreign medical graduates must register with and be screened by the Educational Commission for Foreign Medical Graduates (ECFMG), in order to take the USMLE step examinations and become licensed in the U.S. They must also pass all of the steps of the USMLE.

The USMLE is administered in four parts: USMLE Step 1, USMLE Step 2 Clinical Knowledge (CK), USMLE Step 2 Clinical Skills (CS), and the USMLE Step 3.

When a medical student or medical resident is suspected of compromising the validity, integrity, or security of the examination process, the USMLE and the NBME will investigate. The investigation is to determine whether or not that student or resident obtained proprietary information or helped others to cheat on the USMLE.

The Consequences of Irregular Behavior Charges.

When the USMLE, NBME, or ECFMG has initially determined that a student, medical school graduate, resident or fellow, may have committed some act that may have violated the integrity of the examination, may have attempted to gain an unfair advantage over other test-takers, or may have violated the security of the test, then it will charge that student or resident with what is called “irregular behavior.” This term could probably be interchanged with the word “cheating” but is much broader than and may encompass far more than what you would normally think of as cheating.

A charge of irregular behavior can have many unforeseen adverse consequences. Not only can these be adverse actions taken by the NBME, USMLE, or ECFMG, they may extend even wider.
The NBME, USMLE, or ECFMG may, for example void test scores, prohibit you from taking a test exam for a number of years, ban you from ever taking the step exams again, or may simply mark your transcript of test scores with the finding of “Irregular Behavior” (think of a big red stamp on your transcript that says “Irregular Behavior” or “Cheated”). However, such a finding may also result in the student’s being expelled from their medical school, not receiving a medical degree, or prevented from applying in the match program.

However, before the medical student or resident is officially charged with committing irregular behavior, the USMLE, NBME, or ECFMG sends a letter informing the individual of the charge and giving the person ceratin rights. The letter also offers the student or resident an opportunity to defend the allegation and attend a hearing in front of a committee (usually called the “Committee for Individualized Review” or CIR) in Philadelphia, Pennsylvania.

What to Do If You Receive a Letter from the USMLE Accusing You of Irregular Behavior.

The letter will usually include certain information and analysis including: the number of times the student or resident took the particular Step examination previously, the percentage of actual test questions to which the student was exposed, how well other test-takers did on the same individual questions, the time spent on the questions, the actions the person allegedly committed which violated the organization’s guidelines, and other information that may be relevant regarding the alleged “Irregular Behavior.”

Details on the rights the individual has to retake the tests or to challenge the findings by requesting a hearing is also included. These are contained in a section of the letter or in a separate attachment called “Policies and Procedures.”

If requested in writing in a timely manner, the CIR will schedule a time to review the facts surrounding the allegations (a hearing) and to hear from the individual. The person may just submit an explanation in writing without requesting an in-person hearing, but we recommend strongly against this. The student or resident may request and attend a hearing before the committee, in person or with an attorney (which we strongly recommend), if he or she so desires. The hearing takes place in Philadelphia.

Evidence may be submitted by the student, including his or her own testimony. The student may have legal representation (an attorney) with him or her at the hearing. Hearings have resulted in students having their test scores validated and being allowed to progress with their professional careers unfettered. They have also resulted in bans from ever retaking the step exams (in the most egregious cases).

Important Factors to Consider for a Hearing Before the Committee for Individualized Review.

Attending a hearing before the CIR is not a process that should be taken lightly, not is it a procedure that you should attempt without experienced counsel. We do not recommend attending such a hearing without an attorney and plenty of advance preparation.

When deciding whether or not to hire an attorney to represent you in this matter, consider the cost and time you expended in preparing for and taking these examinations. In addition, consider the time you will lose from your medical education, residency, internship, or future career if your passing scores are not validated and your studies and career are delayed. It seems illogical not to retain the services of an attorney experienced with this type of matter and this type of hearing, given the high stakes at issue. Even if you have some knowledge of law, evidence, and civil procedure, it is difficult to represent yourself while also being your own witness. Those who are not experienced in such matters will make fundamental mistakes that will harm their case.

Procedural guidelines furnished by the committee need to be followed regarding how evidence is given to the committee and presented at the hearing. Preparation for the hearing would include meetings in advance, preparation of questions and answers and other matters to help ensure a proper presentation. One who is not familiar with such proceedings may overlook key issues and concentrate on issues that are not relevant to the committee’s determination. Any presentation of documents for consideration at the hearing must include excellent organization and a professional presentation. This must be done well in advance of the hearing. In certain cases, it may be necessary to hire an expert witness if the issues and facts require it; however, live witnesses, other than the individual charged, are not allowed at the hearing. It is important to note that the CIR will have its own attorney present at the hearing and there are several attorneys who may be on the committee itself.

Finally, anyone with a charge of irregular behavior should remember that the CIR is not comprised of individuals who are “on your side.” The CIR’s purpose is to ensure that the USMLE policies and procedures are strictly enforced and will enforce them if it does not find your case convincing. The best way to make your strongest argument is to hire someone who has experience with CIR hearings and has won cases in front of it.

Everyone needs someone on their side and we strongly encourage you to hire someone who knows the process associated with Irregular Behavior and the CIR and who will fight for your right to defend yourself.

Contact a Health Care Attorney Experienced in the Representation of Medical Students, Interns, Residents and Applicants, Fellows and Those Involved in Graduate Medical Education.

The Health Law Firm and its attorneys represent interns, residents, fellows and medical school students in disputes with their medical schools, supervisors, residency programs and in dismissal hearings. We have experience representing such individuals and those in graduate medical education programs in various disputes regarding their academic and clinical performance, allegations of substance abuse, failure to complete integral parts training, alleged false or incomplete statements on applications, allegations of impairment (because of abuse or addiction to drugs or alcohol or because of mental or physical issues), because of discrimination due to race, sex, national origin, sexual orientation and any other matters.

To contact The Health Law Firm please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: Achal A. Aggarwal is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone: (407) 331-6620.

KeyWords: Graduate medical education (GME) defense attorney, international medical graduate attorney, graduate medical education defense lawyer, lawyer for medical students, medical resident physician attorney, residency program legal dispute, residency program litigation, medical school litigation, legal representation for medical residents, legal dispute with medical school, medical students legal counsel, disruptive physician attorney, impaired medical student legal counsel, impaired resident legal defense attorney, United States Medical Licensing Examination (USMLE) defense lawyer, USMLE defense attorney, National Board of Medical Examiners (NBME) defense counsel, Educational Commission for Foreign Medical Graduates (ECFMG) defense lawyer, ECFMG defense attorney, legal representation for USMLE investigations, legal representation for NBME investigations, legal representation for irregular behavior, irregular behavior defense attorney, irregular behavior defense counsel, health law attorney, The Health Law Firm reviews, reviews of The Health Law Firm attorneys, Philadelphia attorney for ECFMG hearing, Philadelphia lawyer for NBME hearing, Philadelphia legal counsel for USMLE hearing

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2018 The Health Law Firm. All rights reserved.

 

Medical Students, Interns & Residents Beware: A Finding of “Irregular Behavior” Can Ruin Your Medical Career Before it Starts

4 Indest-2009-3By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

A medical student, intern or resident may receive a letter from the National Board of Medical Examiners (NBME), United States Medical Licensee Examination (USMLE) Secretariat advising them that they are suspected of “irregular behavior” on a Step examination. In the case of graduates of foreign medical schools, this will be a letter from the Educational Commission for Foreign Medical Graduates (ECFMG). Although “irregular behavior” is not the same thing as “cheating,” it is often thought of as the same by medical school officials and residency program directors.

A notice of irregular behavior may delay your entry into a residency program, your graduation from medical school and your potential job opportunities. Your examination scores will be held up while the matter is investigated until a Committee review or hearing can be held.

It is imperative that anyone accused of irregular behavior immediately consult with legal counsel experienced in such matters. At The Health Law Firm, we have represented a number of medical students, interns and residents in hearings on irregular behavior and we have consulted with many before on these matters.

Don’t Listen to Bad Advice.

The following are examples of erroneous advice we have heard was given to those accused of irregular behavior:

1. You shouldn’t have a lawyer represent you in such matters because this will make the Committee angry at you.

2. You don’t need a lawyer because you can just explain it yourself.

3. You just write a statement and explain it; the Committee will understand and find in your favor.

4. You do not need to request a hearing on it because if you submit documents, the Committee will review them, find in your favor and no hearing will be necessary.

5. If you request a hearing on the matter, you do not need to attend it in person.

6. If you request a hearing, an attorney is not allowed to represent you at the hearing.

7. You should not worry about the Committee finding against you because you can always appeal the finding or sue in court.

The above advice is wrong. The only advice you should listen to is the advice of an attorney who is experienced in handling matters of irregular behavior.

The Importance of Retaining Experienced Legal Defense.

The biggest problem faced by an individual accused of irregular behavior who does have a valid defense is to concisely and adequately explain the situation. Additionally, you must produce evidence that supports what you are saying.

Someone who is not trained in the legal profession and who is not familiar with such hearings will be unfamiliar with the process even though such hearings are not as formal as court hearings. Additionally, it is easy for a non-lawyer who is not familiar with the rules of the USMLE to fail to address those concerns and get side tracked on irrelevant matters.

Additionally, documents, statements, affidavits, expert witness reports and other documents presented to the Committee as evidence should be well organized, indexed, with a table of contents, pages numbered and summarized. This will better present an organized, easily understood defense. Sending in a few stray documents with no organization or explanation how the documents relate to the issues can be far less than effective.
Consequences of an Irregular Behavior Finding.

If a finding of irregular behavior is made against you, then this usually means that your best score is voided and you must retake it. The Committee may require you to wait a year or more to retake the examination. This can prevent you from obtaining or entering a residency program or it may delay you from graduating. Furthermore, the notation that you were found to have committed irregular behavior will be placed on your Step exam transcript. This will be reported out when your test scores are reported.

As indicated above, many medical decision makers view this as similar to cheating. It may disqualify you for many jobs or residency programs that you would otherwise be considered for.

If the time and money you have spent on your medical career is valued by you, you will act promptly to retain legal counsel experienced in USMLE hearings and procedures to represent you. You wouldn’t perform surgery on yourself. You shouldn’t attempt to represent yourself in such legal matters.

The takeaway message is that retaining an attorney to represent you against irregular behavior allegations could be the difference between a clear record and a mark that will follow you for the rest of your career. Don’t risk jeopardizing your future as a healthcare practitioner. Consult with an attorney as soon as you receive notice of allegations against you regarding irregular behavior.

To learn more on the repercussions of findings of irregular behavior, click here to read one of my prior blogs.

Contact Health Law Attorneys Experienced in Matters of Irregular Behavior Today.

The attorneys of The Health Law Firm provide legal representation to medical students, residents, interns and fellows in irregular behavior allegations, USMLE issues, academic disputes, graduate medical education (GME) hearings, contract negotiations, license applications, board certification applications and hearings, credential hearings, and civil and administrative litigations.

To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620.

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“The Health Law Firm” is a registered fictitious business name of The Health Law Firm, P.A., and Florida professional service corporation, since 1999, and is also a registered service mark. Copyright © 2017 The Health Law Firm. All rights reserved.

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