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Verification horror stories

Credentialing & Verification Update, October 28, 2008

Earlier this month, we asked Credentialing & Verification Update readers to submit your scariest verification experiences. Here’s a summary of the very worst (and by that, we mean the very best) of all the entries.

Some stories are funny and some are downright frightening, but all of them serve as great reminders of the importance of conducting thorough credentialing and well-organized verifications. We will randomly select and notify one winner from all of the entries this week, who will receive a complimentary HCPro book of his or her choice. Happy Halloween!

Incomplete AMA profiles nearly delay docs’ privileges
“While credentialing several doctors, I pulled incomplete AMA reports. Some had no DEA numbers and some were missing school information. I called the AMA and they assured me they were working on the problem, but a month later, the reports were still incomplete! The reports came up complete a week before the renewals were due to our accreditation committee. Without those completed forms my physicians would have been on temporary privileges. Talk about pressure!”

Fire department responds to foreign verification request
“I was credentialing a foreign doctor and was ‘against the wire’ to grant privileges, so I was quickly faxing verifications. A few minutes later, the local fire department called asking what type of emergency we were having. They told me fire trucks were on their way! Turns out, when I dialed ‘9’ for an outside fax line and a foreign county code starting with ‘11’, I had actually called 911! Needless to say, I don’t send overseas faxes much anymore!”

Doc provides a not-so-professional reference
“I was credentialing a new practitioner who had graduated from a top medical school. He had superb training, and—up to a point—very good references. One reference, however, submitted remarks about the practitioner’s 'personal' appearance: his dress, his tastes, and even his personal relationship with her. She wrote about everything but his work!”

Although we had to find a new professional reference, this ‘personal’ reference became a permanent part of the applicant’s credentialing file. We can only imagine the chief medical officer’s and medical executive committee’s laughter. Fortunately, however, his privileges were not withheld due to the inappropriate reference.”

You couldn’t fool us once; you certainly won’t fool us twice
“We began credentialing an applicant to our hospitalist program. That is, until we noticed her application contained three different birthdates, numerous unexplained time gaps, incomplete training, and other missing information. Her application was denied, and we requested that our state medical board investigate her practice. Strangely enough, she recently attempted (we can only hope inadvertently) to get credentialed at our facility again! The truly scary part is that she is still practicing while under investigation.”

This application stinks
“I was having difficulties verifying an applicant’s work history. The applicant gave hazy answers that sometimes made little sense, and even decided to tell me about a time he was admitted to a military hospital as a patient and was so ill that when he was discharged, he needed to buy all new underwear! As time progressed, our verifications of his work history raised so many red flags that he quit returning my calls. That’s probably a really good thing!”

Wanted: Contract docs that aren’t wanted
“My organization contracts with a group for emergency department (ED) coverage that is always trying to get its physicians credentialed for our frequently uncovered ED shifts in very short time periods. I was credentialing one of these docs when a background check revealed a red flag. Digging deeper, I learned the doc was out on $35,000 bond on a first degree felony charge! The contract group wondered if we could still get him credentialed, to which I said ‘not a snow ball’s chance in you know where’. It seems to me that some contract groups will put any physician in an ED to fill the gaps, leaving hospitals liable and patients at risk. Talk about a nightmare.”

More than a ‘misunderstanding’
“I was trying to credential an ED physician with glowing recommendations from residency directors and peers, but his application noted that he resigned from his previous employer due to a ‘misunderstanding’. His DEA had also been suspended for a short time. For two months I tried to get more details from him, but he wouldn't say a word. Our medical staff leaders recommended that the applicant come to an interview with the credentials committee, where the applicant revealed that he had prescribed narcotics for his fiancé, who subsequently overdosed. It’s scary to think that these events may never have surfaced and this physician (who clearly had impaired judgment) could have been treating our patients at our facility.”

We’re sorry we couldn’t share the names or locations of your colleagues who wrote in, but we needed to protect the privacy of everybody involved in these true stories. Thank you to everybody who participated!

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