Healthcare License Management and Monitoring

Last Wednesday, Jan. 25, 2023, The Department of Justice U.S. Attorney’s Office of the Southern District of Florida announced the takedown of a massive nursing diploma fraud scheme. 

Charges were brought against 25 individuals who were allegedly involved in the scheme to sell fraudulent nursing diplomas and transcripts from various nursing schools based in Florida.  

In the United States, most clinicians must be licensed in each state in which they intend to practice and serve patients. This can limit the availability of health services, contribute to provider shortages, and restrict job opportunities for providers. It can also be a financial burden for nurses, due to the fees associated with licensing.

An entire healthcare organization can benefit when medical staff services and HR align.

A medical staff services office comprises medical staff professionals (MSPs) and credentialing specialists. They are responsible for credentialing and privileging medical staff members, keeping up with medical staff bylaws, and more.

In contrast, HR managers and employees are often responsible for promoting employee hiring and retention initiatives, managing financial matters such as payroll, and making sure healthcare regulations are followed.

From disaster privileging to credentialing by proxy and beyond, COVID-19 has profoundly affected medical staff services professionals’ (MSSP) operations and obligations.

Several years ago, my colleague Vu T. Do, PreCheck’s Vice President of Compliance, discussed a growing concern for employers as our investigators noticed an uptake in the detection and reporting of diploma mills. Unfortunately, this is not the only trend with which healthcare employers should be concerned.

The U.S. Department of Health and Human Services (HHS) Office of Inspector General’s (OIG) Work Plan is one of the most valuable resources available for healthcare compliance professionals. The OIG’s work planning process is dynamic and adjustments are made throughout the year to meet priorities and to anticipate and respond to emerging issues with the resources available. Previously, the OIG updated its public-facing Work Plan once or twice a year, but their update cadence has changed as of last month.

The healthcare industry is one of the most complex and highly regulated, which means employers have a greater responsibility to ensure a safe workplace environment not just for their own staff, but also for patients. The past decade has seen advancements in technology and best practices for the industry, with the Affordable Care Act (ACA) placing greater emphasis on quality of care and patient safety. Industry regulators have provided updated guidance and newer technologies have allowed leading organizations and systems to improve the efficiency of their screening efforts.

Patient safety is the backbone of healthcare and the National Practitioner Data Bank (NPDB) plays a critical role in protecting patients from unfit, excluded practitioners.  The NPDB serves its mission to promote quality healthcare and protect patient safety by operating as a reliable workforce tool for users engaged in credentialing, licensing and hiring decisions.

Last week, I traveled to the Emerald City of Seattle, Washington for the National Association Medical Staff Services’ (NAMSS) 39th Educational Conference and Exhibition. Similar to the recent American Society for Healthcare Human Resources (ASHHRA) conference, the theme for this year’s NAMSS conference, “Embracing Change: A Journey of Leadership,” also focused on leadership.

To avoid hiring and engaging unlicensed or sanctioned individuals, ongoing license verification and monitoring is critical. In healthcare, nothing is more damaging than employing a clinician without the proper skills and training to practice at your facility. Failing to properly verify or monitor licenses and certifications will not only result in non-compliance with state and federal rules and accreditation standards, but it will also put patients and staff at risk.

Here are five do’s and don’ts that will aid in your license verification and monitoring initiatives.