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Audit (A-06-04-00024)

11-22-2004
Credentialing and Privileging Practices at Gallup Indian Hospital

Executive Summary

We found that Gallup Hospital did not routinely complete required credentialing, privileging, or personnel suitability reviews for its practitioners. The credentialing and privileging reviews are generally required by industry-wide standards and specifically by IHS Circular 95-16; the Indian Child Protection and Family Violence Prevention Act (Public Law 101-630 &sec; 408) requires background investigations. For the 52 practitioners we reviewed, the hospital did not: (1) verify the credentials for 26, or 50 percent, to determine their current competence; (2) ensure that 14, or 27 percent, had current privileges, with lapsed periods ranging from 6 days to 6 months; or (3) request OPM to perform a background investigation of 23, or 44 percent. Gallup Hospital's management had not ensured that the credentialing, privileging, and personnel suitability review processes received the necessary level of priority in terms of management attention and other resources. As a result, the hospital's management could not assert its full assurance that its practitioners had the appropriate qualifications, authorizations, and personnel history to provide patient care.

We recommended that IHS ensure that Gallup Hospital's management establishes a system to routinely perform credentialing, privileging, and suitability reviews. The hospital should: (1) assign staff to perform the credentialing and privileging processes before the practitioners provide patient care, (2) fully implement the computerized credentialing system to track and monitor the status of its practitioners, and (3) initiate the required OPM background investigations for its practitioners. In its written response to our draft report, IHS stated that all recommended corrective actions had been taken.

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