CPCS Negligent Credentialing and Legal Risk Management 2 — Questions and Answers
Question 1: Which legal doctrine holds hospitals liable for the negligent acts of independent contractor physicians if patients reasonably believed those physicians were hospital employees?
- Respondeat superior
- Ostensible agency (Correct answer)
- Corporate negligence
- Res ipsa loquitur
Correct answer: Ostensible agency
Ostensible (apparent) agency holds hospitals liable when patients reasonably relied on the appearance that the provider was a hospital employee.
Question 2: A hospital fails to query the National Practitioner Data Bank (NPDB) before granting initial privileges to a physician. The physician later harms a patient. What primary legal risk does this create?
- Breach of HIPAA
- Negligent credentialing liability (Correct answer)
- Antitrust violation
- False Claims Act exposure
Correct answer: Negligent credentialing liability
Failing to query the NPDB as required is a core element supporting a negligent credentialing claim against the hospital.
Question 3: Under the Health Care Quality Improvement Act (HCQIA), hospitals must report to the NPDB when a physician's clinical privileges are reduced, suspended, or revoked for more than how many days?
- 15 days
- 30 days (Correct answer)
- 60 days
- 90 days
Correct answer: 30 days
HCQIA requires reporting when adverse privilege actions last more than 30 days.
Question 4: A credentialing specialist discovers a practitioner surrendered privileges at another hospital 'while under investigation.' Which action is MOST appropriate?
- Grant privileges provisionally pending investigation
- Query the NPDB and request a complete explanation from the practitioner (Correct answer)
- Deny privileges immediately without further review
- Table the application until the next credentialing cycle
Correct answer: Query the NPDB and request a complete explanation from the practitioner
The specialist must query the NPDB and obtain full details before a credentialing decision to ensure due diligence and avoid negligent credentialing.
Question 5: Which element is NOT required to establish a negligent credentialing claim in most US jurisdictions?
- The hospital owed a duty to the patient
- The hospital breached its duty in credentialing the provider
- The provider intended to harm the patient (Correct answer)
- The breach caused patient injury
Correct answer: The provider intended to harm the patient
Negligent credentialing is a negligence (not intentional tort) theory, so intent is irrelevant—only duty, breach, causation, and damages are required.
Question 6: A peer review committee recommends termination of a physician's privileges based on quality concerns. The physician alleges the real motive is economic competition. Which federal law provides immunity to the committee if the action met its standards?
- EMTALA
- HCQIA (Correct answer)
- HIPAA
- Stark Law
Correct answer: HCQIA
HCQIA provides qualified immunity to peer review participants when the process meets statutory standards of fairness and thoroughness.
Question 7: A court applies 'corporate negligence' in a credentialing lawsuit. What does this theory primarily establish?
- Liability of the medical staff for peer review failures
- Direct duty of the hospital as a corporate entity to oversee practitioner competence (Correct answer)
- Automatic liability whenever a contracted physician causes harm
- Liability only when a hospital administrator was directly involved in care
Correct answer: Direct duty of the hospital as a corporate entity to oversee practitioner competence
Corporate negligence imposes a direct, non-delegable duty on the hospital itself to ensure practitioner competence, independent of vicarious liability theories.
CPCS Negligent Credentialing and Legal Risk Management 2
Which legal doctrine holds hospitals liable for the negligent acts of independent contractor physicians if patients reasonably believed those physicians were hospital employees?