How Improper Medical Credentialing Can Lead to Medical Malpractice

In the world of healthcare, trust is essential. Patients rely on hospitals and medical professionals to deliver safe, competent care. But that trust can be shattered when a physician is allowed to practice without the proper qualifications. Improper credentialing is a silent but dangerous pathway to medical malpractice—and it’s more common than many patients realize.

What Is Medical Credentialing?

Medical credentialing is the process by which hospitals and healthcare systems verify that a medical provider has the training, education, licensure, and experience required to treat patients. This includes checking for board certifications, disciplinary actions, malpractice claims, and any gaps in a provider’s professional history.

Credentialing is a basic safety measure, and when done correctly, it ensures that only qualified professionals are treating vulnerable patients. The Centers for Medicare & Medicaid Services (CMS) require credentialing for any provider who wishes to bill federally funded programs like Medicare and Medicaid. It’s not just paperwork—it’s the foundation of patient safety.

When Hospitals Cut Corners

Despite its importance, hospitals don’t always follow proper credentialing procedures. Sometimes the process is rushed, incomplete, or ignored altogether. This can allow providers with suspended licenses, falsified credentials, or a history of patient complaints to continue practicing.

A recent example in New Jersey involved a physician who was allowed to work in several healthcare facilities despite accumulating numerous patient complaints and red flags. Patients reported being misdiagnosed, mistreated, and even harmed—but it wasn’t until the situation made headlines that regulatory bodies intervened.

This type of negligence can have devastating consequences. It not only puts patients at risk, but it also exposes hospitals to serious legal liability under the doctrine of negligent credentialing.

What Is Negligent Credentialing?

Negligent credentialing is a legal concept that holds hospitals accountable for failing to properly vet the doctors they employ or contract with. When a hospital allows an unqualified or dangerous provider to treat patients—and those patients are harmed as a result—the hospital may be held liable for damages.

To succeed in a negligent credentialing lawsuit, a plaintiff typically must show:

• The hospital had a duty to ensure the doctor was competent and qualified

• The hospital failed to exercise reasonable care in evaluating the provider’s credentials

• The provider’s incompetence caused harm to the patient

• The harm resulted in measurable damages

Negligent credentialing is not always easy to prove, but courts in many states now recognize it as a valid cause of action, especially when a provider has a clear pattern of misconduct or prior disciplinary actions.

Common Failures in the Credentialing Process

When hospitals fail to properly credential a provider, it’s often due to breakdowns in one or more of the following areas:

• Failure to verify education and licensure: Not confirming that a provider has the required degrees, active licenses, or certifications.

• Ignoring malpractice history: Overlooking or failing to investigate prior malpractice lawsuits or disciplinary actions.

• Neglecting peer reviews: Not soliciting feedback from previous employers or medical boards.

• Delayed or missed re-credentialing: Providers must be re-credentialed every 2-3 years. If this isn’t done on time, lapses can go undetected.

• Inadequate background checks: Failing to check national databases or consult state medical boards for complaints and sanctions.

According to the Joint Commission, one of the nation’s primary healthcare accrediting bodies, credentialing failures can jeopardize a hospital’s accreditation and trigger compliance issues with CMS.

How Patients Are Impacted

When improper credentialing leads to malpractice, the impact on patients can be life-altering. Some of the most common outcomes include:

• Delayed or incorrect diagnoses

• Surgical complications

• Improper prescription or medication errors

• Failure to follow accepted medical protocols

• Inadequate post-operative care

Patients who suffer injuries due to these failures may face long-term health consequences, financial stress from additional medical bills, and emotional trauma.

What Patients Can Do

While hospitals are ultimately responsible for credentialing, patients can take proactive steps to protect themselves:

• Verify your doctor’s license and disciplinary history through your state medical board

• Ask about your provider’s experience with specific procedures or treatments

• Report any concerns about care to hospital administrators or the state board

• Stay informed about your rights as a patient, especially when something feels off

No patient should be in the care of an unqualified provider. If you’ve experienced harm due to questionable or negligent care, it’s important to explore your legal options.

Final Thoughts

Improper credentialing may not make headlines every day, but its consequences are real—and preventable. When hospitals fail to do their job in screening providers, they put patients directly in harm’s way. Accountability matters, not just for individual justice, but for the integrity of the healthcare system as a whole.

If you or a loved one has suffered due to the actions of an unqualified medical provider, there may be grounds to pursue a medical malpractice or negligent credentialing claim. Hospitals must be held responsible when they ignore warning signs—and patients deserve to know the truth about who is treating them.