Keys to Effective Health Care License Verification and Monitoring

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medical license monitoring

It’s among the unthinkable disasters of every health care facility—learning that a “medical professional” didn’t have a valid license to practice. In March 2012, the U.S. Department of Justice reported about such an incident that occurred in New York and New Jersey.

According to the press release, a medical assistant provided care to patients posing as a qualified medical physician between the years 2004 and 2008, but he didn’t have a medical license. In addition to fraudulently submitting claims for reimbursement, the individual also falsified patient medical records.

While the wannabe-doctor did earn a degree from a medical school in Puerto Rico, he wasn’t licensed to practice in the United States or any other state. Since the medical school lacks the proper accreditations, the individual lacked the requirements needed for international medical students to obtain a medical license in New Jersey.

If guilty, this individual could receive a prison sentence of up to 10 years and a fine of $250,000. Although the press release didn’t report if the medical facility faces any charges in light of the information discovered, the organization may lose its ability to participate in federal programs such as Medicare and result in brand damage.

Health Care License Checking and Monitoring
It’s not uncommon for a health care organization to verify a health care professional’s credentials in-house during the initial employee screening process. In-house procedures used to verify medical licenses, certifications and sanctions can vary according to a number of factors, including the organization’s procedures as well as the individual performing the checks.

These variations can expose a company to screening inconsistencies, which can create legal and safety risks. Furthermore, the license monitoring that follows the hiring process is a huge undertaking for a facility to take on manually. Falling behind or committing an error can lead to non-compliance, penalties and staff shortages.

By following certain credential-check and monitoring best practices, a health care organization can be better equipped to remain in compliance. Such practices include:

  1. Using the services of a third party: When an organization delegates the tasks of credentialing and license monitoring to a professional service with an established process, it minimizes the risks that result from employee turnover, over-burdened staff and human error. A third party vendor that specializes in credentialing and license monitoring can help streamline these processes and facilitate a compliant program.
  2. Exceeding the minimum requirements: If an organization conducts the minimum requirements, it’s at risk for missing sanctions and vital information that could make an individual ineligible for employment. By running a thorough battery of checks that are tailored to specific roles, the facility can better ensure the quality of care and services provided.
  3. Using automated tools and notices: Automated systems can track a medical professional’s license status and provide alerts regarding testing and continuing education requirements, as well as license renewals. Such tools help keep an organization compliant and its medical staff in good standing.
  4. Ongoing monitoring procedures: Employee licensure monitoring is a best practice that helps health care organizations ensure their staff members have the required credentials. While some states require monthly license monitoring of health care professionals, it’s wise for organizations not in those states to consider a policy that includes quarterly monitoring at a minimum.

The legal landscape regarding health care providers and their employee background screening programs is ever-evolving, so it’s important that organizations integrate best practices and regular policy evaluations into their credential check and monitoring program.

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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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