Staff Privileges & Credentialing

Were You Denied Privileges or Credentialing?

Physicians and other healthcare professionals are entitled to certain protections under federal and state law in the credentialing process. The hospital will provide specific procedures for the credentialing process. Hospitals also determine the extent to which the physician may practice in its facilities, referred to as “privileges.”

Credentials can be denied and privileges restricted because of criminal convictions, incomplete disclosure of all pertinent issues in the application, medical malpractice, professional license discipline, or questions regarding medical education or training. Credentialing can be used for improper purposes or influenced by invalid factors.

You should seek qualified legal assistance to assist you in addressing credentialing issues. Delegal Law Offices will guide you through the appeals and fair hearing processes. If you are dissatisfied with the result of your credentialing hearing, Delegal Law Offices will also help you understand litigation options.

A hospital owned by the government is required to ensure that those applying for staff privileges are afforded due process and equal protection, and at least one court has held that the same obligations apply to private hospitals. Several state and federal statutes require fair evaluation of staff applications for privileges, and a fair hearing.

Peer Review

The Healthcare Quality Improvement Act of 1986 (“HCQIA”) is a federal law that was enacted to create a national tracking system of physicians with a history of medical malpractice payments or adverse actions, and which created the National Practicioner Data Bank. The HCQIA provides immunity for most civil cases to health care providers who participate in a legitimate peer review process.  The statute exempts actions based primarily on the physician’s: (i) lack of  membership in a professional society or association; (ii) fees or advertising; (iii) participation in a prepaid group health plans, salaried employment or other manner for delivering health services; (iv) association with a private group practice of a particular class of health care practitioners; or (v) any other matter that does not relate to the competence or professional conduct of a physician are not considered to be professional review actions based on the competence or professional conduct of the physician.

The Health Care Quality Improvement Act of 1986 requires hospitals to establish peer review processes. A peer review process only provides immunity when: (1) actions were taken with the reasonable belief they were in the furtherance of quality care, (2) reasonable efforts were taken to gather the necessary facts, (3) sufficient notice and a hearing is given, and (4) a reasonable belief that action was warranted by the facts exists.

If you are a medical staff applicant or member you are entitled to certain rights in applying for or protecting your privileges. Delegal Law Offices may be able to help you obtain hospital privileges or help you appeal hospital decisions and get your privileges reinstated.

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