Wednesday, January 12, 2011

NAMSS Member Seeks Input on Medicare/Medicaid Sanctions

A NAMSS member has been asked to conduct a survey asking the following question:

“What provisions are listed in your bylaws regarding possible actions that may be taken when a medical staff member has been sanctioned by Medicare/Medicaid?”

Feel free to post your examples in the comment field on the blog or send them to by Thursday, January 20.


Unknown said...

This falls under our automatic relinquishment section.

Heidi Thompson, CPMSM, CPCS
University of Utah

Anonymous said...

Medical Stafff Bylaws Corrective Action state the following:

Upon conviction of a criminal offense related to healthcare (unless the Appointee has been officially reinstated into the Federal healthcare programs by the Office of Inspector General (“OIG”) and provided proof of such reinstatement to Hospital); or upon sanction, exclusion or investigation (civil or criminal) by any Federal or state enforcement, regulatory, administrative or licensing agency; or upon becoming otherwise ineligible for Federal or state program participation; or upon being listed on the General Services Administration List of Parties Excluded from the Federal Procurement and Non-Procurement Programs, the Member Staff Member’s appointment and privileges shall be terminated. Notwithstanding the foregoing, in the event of any civil or criminal investigation of any Appointee by any Federal or State enforcement, regulatory, administrative or licensing agency prior to any sanction or other action, there will be an automatic suspension of the Appointee’s appointment and privileges pending review of the Appointee’s hospital privileges by the Medical Executive/Credentials Committee which review shall be conducted according to written criteria adopted by the Governing Body upon recommendation of the Medical Executive/Credentials Committee, which criteria shall be consistently applied and which criteria shall ensure that the impact of the investigation of the Medical Staff member on the reputation and community standing of the Hospital is considered in determining appropriate action, to include suspension and termination, if appropriate under application of the criteria.