Credentialing, privileges and peer review all represent serious issues for medical professionals that must be expertly addressed.
Credentialing is a critical issue for staffing at hospitals, surgical centers and other medical facilities. Many medical professionals are blocked or receive denied applications for Medicare or Medicaid privileges because of something in their history — from medical malpractice issues and professional licensure discipline to criminal convictions. When it comes to credentialing or recredentialing, it is absolutely crucial to give a full disclosure of all issues. This means that in addition to answering everything correctly, no pertinent information can be omitted.
For many physicians, hospital medical staff privileges are a necessary gateway to treating patients; that said, they are an often-overlooked area. The Joint Commission on the Accreditation of Healthcare Organizations is looking much more seriously at these issues because of the integration coming under the Affordable Care Act.
Peer review can arise in various situations when medical professionals are alleged to be disruptive, have a number of bad outcomes or are in a high-risk specialty, among other circumstances. It is important to realize that peer review is often politically or economically motivated and that peer review hearings are not always fair. Physicians will often wait until an investigation has started and put their careers in jeopardy — termination revocation summary suspension of medical staff privileges can lead to reports to the federal National Practitioner Data Bank.
All of these are immensely complex and highly specialized health care law issues that require experienced counsel with comprehensive knowledge of health care law.
Our Orlando hospital and medical staff lawyers at Lowe & Evander, P.A., have extensive experience helping doctors and facilities address these issues in the best possible ways — efficiently, economically and effectively. We represent hospitals having exclusive agreements that have employment provisions that terminate all privileges when employment is terminated. This enables us to address all privilege issues proactively by reviewing and helping professionals understand what they are getting into, as well as potential exit strategies.
We can also help doctors with disclosing all information in credentialing applications and can reach out to specialists as necessary. We can find creative ways to negotiate, investigate bylaws and get professionals on staff.
Additionally, our experience working on department of health cases resulting from peer review action and termination revocation of privileges readies us to address any related issues.