Professional Licensing and Medical Credentialing

The healthcare lawyers of Hamil Little advise and advocate for physicians and other licensed healthcare providers whose livelihoods depend upon professional licenses and credentialing. Hamil Little is AV-rated by Martindale Hubbell and has offices in midtown Atlanta and in the downtown, Medical District of Augusta, Georgia.

WE PROTECT PHYSICIANS

Our firm’s area of focus and expertise is healthcare law and representation of professionals. We represent physicians, physician groups, physician associations, numerous other licensed professionals, and healthcare businesses owners. We protect the professional and financial interests of healthcare providers. If you have an adverse event, risk or issue that concerns any aspect of your professional license or credentialing, call us today.

Atlanta and Augusta, Georgia Medical License Attorneys

With extensive experience representing physicians and other professionals, we provide high quality legal representation to every client, including, by way of examples, the following legal services include:

  • Georgia Medical Composite Board investigations and disciplinary actions
  • Georgia Pharmacy Board complaints and disciplinary actions
  • Violations of the Georgia Controlled Substances Act
  • Federal Law enforcement investigations, including CMS, OIG, HHS, FBI and DOJ
  • Medicare Fraud Investigations
  • DEA investigations and suspension or loss of DEA registration
  • Administrative hearings, license appeals and other administrative law matters
  • Adverse NPDB reporting
  • Suspension or loss of hospital privileges
  • Peer review, disciplinary and adverse employment action by a hospital or medical practice
  • Termination of employment

Professional Licensing. Medical professionals, physicians especially, are subject to many potential actions and disciplinary processes with regard to the various licenses and board certification they may hold. Hamil Little attorneys draw on extensive background and experience to protect the licenses of medical professionals. While much of our law practice is devoted to physician representation, we also represent pharmacists, nurses, nurse practitioners, clinical nurse specialists, nurse midwives, certified clinical psychologists, clinical social workers, counselors, physical therapists, occupational therapists, social workers and others.

Professional Credentialing. Professional credentialing involves a giant data mess. Unfortunately, there is not single clearing house to handle all the information that all employers and third-party payers might need to conduct their due diligence by way of professional credentialing. For the physician, the process, though necessary and mostly unavoidable, cumbersome, time-consuming and full of professional hazards.

All hospitals, insurers and other entities desire, of course, to ensure that their physicians are qualified, competent and have proper training for the purpose the physician will serve. This process, most often referred to as “credentialing,” can be taxing and lengthy, often taking more than three months to complete the submission of initial and supplemental paperwork and correspond with an entity’s credentialing department. For the physicians and other medical professionals, the process can also be hazardous professionally, as a problem raised in the credentialing process with one entity can have a domino affect that impacts credentialing with other entities.

Hospital credentialing usually begins with an application to practice at the hospital and submission of curriculum vitae and similar documentation (e.g., medical degrees, residency certificates). The applicant will typically include professional references and be required to disclose pertinent negative events (e.g., termination due to competency; criminal offenses).

Most physicians, either due to employment or the needs of private practice ownership, find that they must participate in the networks of third party payers. The process of insurance credentialing typically involves evaluation of a doctor’s education, training, residency, licenses and any specialty certifications. This undertaking often includes assembling complete information about a physician’s background and qualifications; checking information about the same provided by the physician against independent, reliable sources, such as the National Practitioner Data Bank; communicating with State licensing departments to confirm there are no limitations on the physician’s license; review of malpractice claims history; review of hospital privileges history; and confirming all aspects of relevant training. Third-party payers may review physician credentials on a routine schedule for all physicians in the payer’s network.

Government payer credentialing (e.g. Medicare and Medicaid) is a similar but different process. Generally speaking, all payors want to make sure, as much as possible, that they are paying real, qualified, licensed professionals for legitimate billing. The requirements for credentialing with government payers is not the same as private payers, though there may be overlap in some requirements.

Call Us Today

We strive for excellence in protecting our physician clients and advocating for their best interests. To schedule a consultation, email us at info@hamillittle.com or contact us at our office nearest you.