Negligent Credentialing and Legal Risk Management Flashcards
7 cards from real CPCS practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Negligent Credentialing and Legal Risk Management flashcards as text
Which legal doctrine holds hospitals liable for the negligent acts of independent contractor physicians if patients reasonably believed those physicians were hospital employees?
Answer: Ostensible agency
Ostensible (apparent) agency holds hospitals liable when patients reasonably relied on the appearance that the provider was a hospital employee.
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?
Answer: Negligent credentialing liability
Failing to query the NPDB as required is a core element supporting a negligent credentialing claim against the hospital.
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?
Answer: 30 days
HCQIA requires reporting when adverse privilege actions last more than 30 days.
A credentialing specialist discovers a practitioner surrendered privileges at another hospital 'while under investigation.' Which action is MOST appropriate?
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.
Which element is NOT required to establish a negligent credentialing claim in most US jurisdictions?
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.
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?
Answer: HCQIA
HCQIA provides qualified immunity to peer review participants when the process meets statutory standards of fairness and thoroughness.
A court applies 'corporate negligence' in a credentialing lawsuit. What does this theory primarily establish?
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.