Healthcare Industry Risks: Credentialing Exposures

A new advisory from Chubb details how certain adverse factors are accelerating credentialing-related risks for the healthcare industry. Credentialing-related lawsuits are burdensome both in terms of damage awards and expense costs.

Consider briefly the negative impact of the following credentialing-related lawsuit scenarios:

• A $7.6 million jury award in a retaliation lawsuit to a physician whose medical staff privileges were suspended after the physician complained about substandard hospital policies and the poor care that patients were receiving.
• An $8.5 million jury verdict against a hospital that had permitted a physician of limited neurosurgery experience to perform spinal surgery involving "off-label" use of surgical rods, resulting in significant brain and spinal injury to the patient.
• A $70 million settlement paid by a multi-hospital health system that allegedly engaged in improper financial relationships with doctors in violation of federal anti-kickback laws.

In the advisory, learn more about:

• Trends in allegations and safeguards
• Root causes of lawsuits
• Risk mitigation

At a time when the healthcare industry is undergoing dramatic change, effective leadership requires that every organization adopt a sound credentialing program and take ownership of the vital matters pertaining to provider appointment, retention, and performance review. It also calls for taking appropriate risk management measures to manage and contain interpersonal conflict and disruptive behavior, which are significant liability threats for all health care settings.

Anything less than a coordinated approach to credentialing providers may introduce certain risks, including lapses in patient care, critical communication gaps and spiteful retaliatory actions.