4 Best Practices to Mitigate the Risk of Negligent Credentialing

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negligent medical credentialingNegligent credentialing lawsuits are the latest risks some hospitals must now contend with, according to a recent article by the Society for Human Resource Management. Earlier this year, the Utah High Court reached a decision allowing hospitals to be held culpable for negligent credentialing in medical negligence lawsuits. Under certain state laws a hospital must prove it took every preventable measure to ensure the physician was capable, before granting them privileges. Otherwise the hospital can be held accountable in a malpractice suit. Hospitals can help avoid this kind of liability by implementing more thorough and consistent credentialing and background checking programs.

Often hospitals and health care organizations perform their credentialing in-house and that process can vary by the individual(s) performing the task. Introducing inconsistency to the credentialing process can lead to an increase in legal risk for the health care provider. By adopting these four credentialing best practices, hospitals can better protect themselves against negligent credentialing claims.

1. Exceed minimum requirements
Many hospitals create a credentialing program that meets the minimum set of medical and licensing credentialing requirements called for by The Joint Commission and/or other standards. However, this could put the organization at risk, as there are many other types of background and criminal checks available to determine whether a physician should have privileges to practice at their facility. Data from abuse and sex offender registries as well as legal records are all good indicators of a physician's future performance.

2. Enlist a third party
Conducting credentialing in-house leaves plenty of room for inconsistency and basic human error. Some institutions believe they are safeguarded from error because they have a credentialing policy in place for staff to follow. However, following a weak policy, or only sporadically adhering to policy- will not help to catch incompetent physicians. Enlisting an experienced third party vendor to supplement and enhance the credentialing process is an optimal solution for streamlining the policy and further eliminating risks from human error.

3. Be prepared
Collect and organize materials in such a way that, in the event of a problem or audit, the credentialing staff have all necessary records and proof of due diligence. When background screening a potential candidate, create a system of documentation that shows how the background check process meets or exceeds industry regulations. If the candidate has been sued in the past, obtain evidence up front from that case, including what happened and what the results were. Have these materials ready, because a quick and complete response to claims will minimize time and cost to the hospital.

4. Continually monitor employees
It is a best practice to monitor the employee’s professional record and civic good standing either monthly or quarterly. If a physician or other medical employee passes an initial background check, it does not guarantee their continued competency. It is also possible that physicians might withhold negative information such as previous malpractice or personal problems during credentialing. This negative information may come to light months or years after they are granted privileges. By performing credential and background checks regularly, the hospital can better protect itself from being implicated in ensuing claims.

As the legal landscape continues to evolve, hospitals must regularly evaluate their background screening and credentialing program to ensure they are minimizing the risk of negligent credentialing. Follow these four best practices and you will be on your way to a safer program with less exposure to risk.

Discover other best practices that you can take to mitigate the risk of only using a basic credentialing process to hire health care professionals in the complimentary white paper: 10 Best Practices in Health Care Background Screening.


The HireRight Blog is provided for informational purposes only and should not be construed as legal advice. Any statutes or laws cited in this article should be read in their entirety. If you or your customers have questions concerning compliance and obligations under United States or International laws or regulations, we suggest that you address these directly with your legal department or outside counsel.



HireRight is a leading provider of on-demand employment background checks, drug and health screening, and electronic Form I-9 and E-Verify solutions that help employers automate, manage and control background screening and related programs.

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