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Reduce your Credentialing Liability and Avoid Medical Malpractice Lawsuits

November 4, 2020

Negligent Credentialing in Healthcare 

Credentialing patient-facing staff is a fundamental responsibility of a healthcare organization. Failure to thoroughly credential providers risks unfavorable patient outcomes and tremendous liability for healthcare organizations.

Hospitals’ due diligence in selecting, hiring, and retaining only fully credentialed and qualified physicians is therefore both a responsibility to patients, other medical staff, and a necessary part of risk management. Here’s what hospitals should know about avoiding negligent credentialing litigation.

How Do Lawyers Prove Negligence?

Lawsuits holding hospitals liable for medical negligence have increased as the practice of telehealth increases the number of physicians practicing remotely. In negligent credentialing lawsuits, a patient may sue a provider for malpractice and the medical institution for not properly credentialing the physician.

However, proving negligence is a multi-step process where first it must be established that the following events occurred.

  1. A legal duty existed between the plaintiff and defendant
  2. The defendant breached that duty
  3. The plaintiff received an injury
  4. A causal relationship existed between the defendant’s breach of duty and the plaintiff’s injury

If all of these criteria are met, the plaintiff may have grounds for pursuing a lawsuit and seeking damages against both the practicing physician and the overseeing medical institution. Some consequences of negligent credentialing in addition to damages can be severe and may include accreditation loss, exclusion from participating in Medicare and Medicaid, sanctions, civil monetary penalties, and steep fines for both the physician and the supervising institution.

However, there are steps that a medical institution can take to prevent negligent credentialing consequences. Although managing credentialing files requires heavy administrative oversight, trusted technology solutions can augment the medical credentialing specialist or the medical staff services team and relieve some of the burden.

Steps to Prevent Negligent Credentialing

While negligent credentialing lawsuits are on the rise, compliance and medical staff services teams can protect their organizations from negligent credentialing lawsuits by taking the proper steps to mitigate risk by investing in the proper technology and credentialing processes from the start. Here are several ways to prevent risk:

  • Know updated state licensing regulations and verify license type and status
  • Adhere to federal and state regulations and medical governance requirements
  • Invest in trusted third-party credentialing services
  • Seek trusted legal counsel

Verisys, a URAC Accredited and NCQA Certified Credentials Verification Organization, (CVO) offers professional credentialing services that protect health systems from negligent credentialing risk by screening healthcare applicants with nearly 100% identity match rates, verifying credentials and records from a data platform of millions of aggregated and matched records, and continually monitoring against 5,000 primary source publishers.

Verisys notifies its clients of license expirations and impairments, provider exclusions, sanctions, debarments, and disciplinary actions, indictments, among other adverse events derived from primary sources such as OFAC, Social Security Death Master File, DEA, Sex Offender and Abuse registries. Since many institutions or physicians may fail to report to the National Provider Data Bank (NPDB) it is critical to have real-time access to independently verified and aggregated actionable data.

As the gold-standard credentialing specialist in the industry since 1992, Verisys’ range of data, including its proprietary database, FACIS®, and its verification services provide peace of mind knowing you are doing everything you can to keep your patients safe and your organization out of litigation.

Susen Sawatzki Written by Susen Sawatzki
Healthcare Industry Expert
Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives.
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