Query insurance carriers for an applicant’s malpractice suit history

This week’s quick tip comes from an exchange adapted from HCPro’s webinar, “Verify & Comply: Credentialing Standards Compared and Contrasted,” available now on demand. Carol Cairns, CPMSM, CPCS, advisory consultant with The Greeley Company and president of PRO-CON, an Illinois-based medical staff services consulting group, discusses the hospital’s responsibility to query insurance carriers.

Q: Do most hospitals query insurance carriers to obtain an applicant’s malpractice suit history even though this step is not required by The Joint Commission?

Cairns: Yes. When I speak at state and national meetings, I’ll poll the audience, and a significant number of attendees say they are querying the carriers directly—anecdotally I believe it’s about 75%.

In my experience, one of the reasons you want to do this is because the applicant doesn’t always tell the total truth. I’ve learned that the hard way. Some applicants don’t tell the truth, and then when you go to the carrier, you find out that there were more suits than the applicant admitted.

Another thing that happens is the carrier sometimes has a different opinion about the suit than the applicant. On most applications, applicants are asked to describe the suit and what happened, and sometimes you’ll find that the carriers have a different version.

The most valuable reason organizations do this is because if you query the carrier and ask for pending cases, you’ll get information on current pending cases, which isn’t available through the National Practitioner Data Bank. I was involved in a case of alleged malpractice and negligent credentialing that occurred in Pennsylvania. That patient was treated 10 years previously, and the case was still in the judicial process. So, how many other cases were still pending for that physician? This is something the hospital and the medical staff, as well as the governing board, would want to know and should be evaluating.

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