Credentialling: Preventing Lawsuits and Unwanted Regulatory Scrutiny

Finding and retaining quality medical talent is a continuing challenge for hospitals, health care facilities, or medical practices. Competent, motivated and ethical clinicians are needed more than ever in today’s clinical space. Yet many health care entities fail to make certain that a new hire is thoroughly and securely vetted before employment, creating significant compliance risks for their organization. Medical credentialing is a crucial process in healthcare, ensuring that all health care professionals meet the necessary qualifications and standards to provide quality patient care. Valid licenses and certifications are not only required by law, but they are also often requested by third party payers, regulatory or law enforcement investigators and sometimes, even patients.

While a rigorous credentialing process ensures that an incoming provider possesses the clinical skills, experience, and adherence to professional standards required for the job, it is important to address any potential legal problems which may accompany the new hire, including prior lawsuits, restrictive covenants and other red flags.

The importance of a thorough credentialing process cannot be understated. Failure to conduct rigorous and meticulous onboarding for new providers can create potential liability and civil penalties, along with tarnished reputation for any health care facility. So careful and scrupulous medical credentialing is crucial for maintaining healthcare standards, ensuring patient safety, and holding providers accountable. A solid background check will include searches of sex offender registries, criminal history, regulatory (federal and state) authorities and federal payor exclusion lists, along with a pre-employment drug test. It is equally important that employers verify the status of all certifications (including specialty certifications), or accreditations claimed by the provider.

As an essential component of risk management, the credentialling process, like medical documentation, must be performed correctly, each and every time. All health care employers must have the right team in place to perform conscientious, careful screening of new clinical hires, so that no stone is left unturned in vetting and screening. All HR staff should be fully trained in the proper screening process to reduce organizational risks, while still ensuring a fair and inclusive hiring process which culminates in the hiring and retention of quality clinicians.

Learning Outcomes:

• Help health care employers avoid employee lawsuits
• Ensure full compliance with third party payer guidelines
• Avoid regulatory scrutiny from licensing boards and other regulators
• Ensuring all new hires are properly credentialed and have provided full disclosure on their resume or CV
• Understanding the proper mechanisms for compliant credentialing, including the National Practitioner Data Bank, licensing board websites and the OIG Exclusion List
• Reducing the risk of lawsuits and regulatory referrals by ex-employees

Areas Covered in the Session:

• How to perform full background checks
• How to interview and onboard new employees
• Checklist for full and compliant credentialling
• How to deal with employee complaints, conflicts or threats
• The best sources for information on new employee candidate credentials
• How to ensure that new employees have no impairment issues
• Managing and maintaining a responsive and compliant human resources team
• Live Q&A Session

Recommended participants:

• Medical Practice Owners
• Administrators and Executives
• Hospital and Practice Medical Directors
• Director of Medical Staff
• Credentialing Committee
• Bylaws Committee
• Medical Practice Credentialing Team
• Health Care Providers
• Health Care General Counsel
• Health Care Compliance Officers
• Health Care Practice Managers
• Health Care Attorneys
• Credentialing Specialists
• Directors of Nursing
• Hospital and Medical Practice HR Heads
• HR Managers and Recruiters
• Medical Staff Leaders
• Chief Medical Officers

Presenter Biography: