OIG focuses on medical credentialing

The Office of Inspector General's (OIG's) recently released draft compliance guidance identifies medical staff credentialing as a risk area. The draft guidance was published in the June 8 Federal Register. 

The new document expands on the OIG's 1998 compliance recommendations, according to OIG spokesperson Judy Holtz.

The guidance states that some medical staff credentialing practices may violate the anti-kickback statute of the Social Security Act. Specifically, the OIG warns hospitals against making practitioner privileging decisions based on referrals and volume criteria beyond what is necessary to ensure clinical competence.

However, the guidance also notes that credentialing policies that deny privileges to physicians with significant conflicts of interest do not appear to violate the anti-kickback statute.

The draft guidance advises hospitals to "examine their credentialing practices to ensure they do not run afoul of the anti-kickback statute."