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Licensing, Staff Privileges, and Credentialing

Overview

State licensure, medical staff privileging and credentialing matters can have numerous impacts on providers and their businesses, such as reports to state and national databanks, additional actions by other states, termination of staff privileges and other relationships, as well as third party payor de-participation. Due to the domino effect that often accompanies sanctions or settlements of licensing or privileging matters, it is very important to retain experienced healthcare counsel who can assess the collateral damage that could result. Our attorneys understand the potential consequences and will strive to settle matters in a manner that results in the least possible collateral effects.

Licensing Matters

Licensure investigations can arise from a variety of sources, such as patient complaints or complaints from other health care providers. Sometimes investigations are closed quite quickly when the complaint has no merit. Even when complaints seem to have no merit, we always recommend that providers always have counsel present when speaking with investigators.

Staff Privileges

Central to many physicians’ practices are their hospital affiliations and privileges. Without these hospital privileges, physicians may be hard pressed to get referrals or patients. Further, if a provider loses privileges at a hospital, or has those privileges limited in any way, it could be reportable to the NPDB, which makes it even more difficult to obtain credentialing at a hospital or find employment in the future.

Our attorneys frequently represent physicians who are at risk of being terminated from medical staffs or are being denied membership. Our attorneys guide physicians through the formal appeals process and represent providers during the fair hearing process if applicable. We can also evaluate the feasibility of litigation and represent providers if litigation is recommended.

Credentialing

Many clients come to us because of difficulties with getting credentialed or maintaining credentials in HMOs, PPOs or other similar provider networks. Disaffiliation from a payor network can have financial consequences as well as a stigma attached. We have successfully represented many providers with regard to maintaining credentials in various payor networks.


Services

We provide assistance in the following areas:

  • Medical license defense
  • Medical board hearings
  • Nursing license defense
  • Nursing board hearings
  • Hospital medical staff privileges
  • Physician Credentialing