$8 million.1 $11 million.2 $524 million.3 These staggering costs should serve as a wake-up call for healthcare organizations everywhere. They prove that juries and judges across the nation are taking negligent credentialing cases seriously. 4 Verdicts in the millions of dollars are being awarded against hospitals and healthcare systems found responsible for adverse events caused by providers that, as proven in court, had practice issues that should have been caught in a thorough credentialing process. More than half of all states now recognize negligent credentialing as a reason for litigation against healthcare organizations.4

The ECRI Institute states that approximately 7 percent of physicians provide falsified information on their credentialing applications.5 This number indicates that though the vast majority of care providers are honest, facilities do have to be aware of the few who seek their own advancement at the expense of facilities and patients.

In the 1980s, one case first brought negligent credentialing under scrutiny. Dr. James C. Burt, a gynecologist, performed thousands of unnecessary surgeries on his patients, leaving them with a lifetime of medical complications. According to a 1988 New York Times article, Burt was “neither a fellow of the American College of Obstetricians and Gynecologists nor certified by the American Board of Obstetrics and Gynecology.”6 In fact, he was not even a licensed surgeon. Not surprisingly, Burt’s patients brought lawsuits against him and the hospital that allowed him to perform these surgeries.

More recent cases include an anaesthesiologist who worked while under the influence of narcotics, nearly causing the death of a patient7 and a surgeon who implanted the shaft of a screwdriver into a patient’s spine instead of titanium rods. The screwdriver snapped just a few days after surgery forcing the patient to have additional operations.8 In both cases, the lawsuits alleged the hospitals had granted privileges to these doctors despite known or undiscovered issues. These and other incidences serve to illustrate how a flawed credentialing system can allow medically incompetent physicians to provide care, leading to disastrous results for patients, not to mention bad publicity and potential lawsuits for hospitals.

Though facility administrators have the ultimate responsibility for a complete and thorough credentialing and privileging process, they can’t do it alone. They need a strong compliance team led by a well-trained compliance and privacy officer who’s given the right tools to build an effective program. Protect your patients and your facility. Contact us to learn more about , the only operational security and compliance management solution to Experience Healthcare.

Sources:

  1. http://www.kattenlaw.com/illinois-appellate-court-upholds-8-million-negligent-credentialing-verdict-for-hospitals-failure-to-follow-credentialing-criteria-11-29-2007
  2. http://www.aans.org/Media/Article.aspx?ArticleId=45765
  3. http://blogs.lawyers.com/2013/04/jury-gives-hmo-dose-of-its-own-medicine-with-524m-verdict/
  4. http://www.piam.com/news/malpractice/jan2014/credentialing.php
  5. https://www.ecri.org/Products/Pages/Credentialing.aspx
  6. http://www.nytimes.com/1988/12/11/us/charges-against-doctor-bring-ire-and-questions.html
  7. http://www.managedcaremag.com/archives/0612/0612.credentialing.html
  8. http://www.nbcnews.com/id/11830537/ns/health-health_care/t/jury-awards-million-screwdriver-case/#.VVX_22fTDIU

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