QUESTION:

We are currently reviewing the application of a physician and have encountered several red flags during credentialing.  Our main concern is that the physician failed to disclose on his application a prior hospital where he practiced and where his privileges were restricted – information we uncovered through a National Practitioner Data Bank query.  Throughout the process, the physician has been largely unresponsive and difficult to work with, and he has explained the omission as an oversight by his office staff. Given the nature of the restriction, however, it seems unlikely this affiliation would be easily forgotten.  How should we proceed if we believe the explanation may not be truthful?

ANSWER FROM HORTYSPRINGER ATTORNEY MARY PATERNI:
While some misstatements and omissions on application forms may be benign, others can be serious, and your concerns are well founded.  Because this is the applicant’s first interaction with the Medical Staff, it is important that they make a strong impression.  Beginning that relationship with potentially intentional omissions may signal future issues if the applicant is appointed and granted clinical privileges.

If you do not already have one, consider incorporating into your Medical Staff Bylaws an administrative process that addresses an applicant’s failure to disclose pertinent information on their application.  Specifically, the Bylaws should state that the hospital will stop processing the application upon discovery of a misstatement or omission.  The applicant should then be notified of the issue and given an opportunity to respond, after which the hospital may determine whether to resume processing the application.  We also recommend including corresponding language in the attestation the applicant signs upon completion of the application.

Because this is an administrative issue – not an adverse recommendation – the Bylaws should make clear that a decision to stop processing an application due to a misstatement or omission is not a “denial” and does not give rise to hearing or appeal rights.  In other words, the hospital isn’t rejecting the application based on the physician’s competencies, training, or experience.  The application simply won’t move forward because the applicant failed to fully or accurately disclose information needed to fully vet his application.

If you have a quick question about this, e-mail Mary Paterni at mpaterni@hortyspringer.com.