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Tip of the week: Avoid negligent credentialing suits by following up on red flags during verification

Credentialing & Verification Update, March 12, 2008

Case law has established that hospitals, and more specifically their medical staff credentialing committees, are required to do more than simply verify the information provided on a medical staff candidate's application.

They also must investigate "red flags" that may indicate a problem with the potential to jeopardize patient safety. Help avoid negligent credentialing claims by keeping an eye out for, and following up on, red flags including:

• Substantial or questionable malpractice claims history
• Inconsistencies between application and verification information
• Missing documents, such as reference letters, proof of board eligibility, or certification
• Invalid Drug Enforcement Agency number
• Adverse reports from the National Practitioner Data Bank or other organizations
• Disciplinary actions, Medicare sanctions, or license actions
• Criminal convictions
• Information suggesting poor clinical performance at other facilities
• Revocations, suspension, or curtailment of medical staff privileges at another facility
• Unexplained time gaps (e.g., between graduation from medical school and date of application or between hospital staff memberships)
• Lack of malpractice insurance
• Evidence of alcohol or drug abuse problems
• Frequent moves from one city to another
• Poor peer references (e.g., due to clinical performance or difficulty with members of hospital or medical staff)
• Requested privileges differ from those requested by physicians in the same specialty
• Removal from a managed care organization provider panel

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