Applications should ask hard questions
This facility’s queries leave no stone unturned
Item #15 on Fremont-Rideout Health Group’s application for appointment to the medical staff reads:
PROFESSIONAL DATA
Practice Information
Please answer each of the following questions in full. If the answer to any question is "yes," please provide full explanation of the details on a separate sheet and attach.
1. Have any disciplinary actions been initiated or are any pending against you by any state licensure board? Yes_____ No_____
2. Has your license to practice in any state ever been denied, limited, suspended, or revoked? Yes_____ No_____
3. Have you ever been restricted from participation in any private, federal, or state health insurance program (for example, Medicare, Medicaid)? Yes_____ No_____
4. Has your narcotics registration certificate ever been limited, suspended, or revoked? Yes_____ No_____
5. Is your narcotics registration certificate currently being challenged? Yes_____ No_____
6. Have you ever been convicted in a felony action? Yes_____ No_____
7. Have you ever been reported to the National Practitioner Data Bank by any source? Yes_____ No_____ If yes, please provide copies of these reports.
This paragraph is at the end of the application:
"I hereby affirm that the information furnished by me to the staff is true to the best of my knowledge and is furnished in good faith. I understand that willful and substantial omissions or misrepresentations shall result in denial, modification, or revocation of my medical staff membership and/or clinical privileges. If the application is found to contain any errors, immediate denial of the application will result."
On the facility’s application for reappointment, Item #7 reads:
"I hereby certify that:
(a) My medical staff appointment or clinical privileges have never been denied, revoked, or terminated by any hospital or health care facility for reasons related to clinical competence or professional conduct.
(b) I have never been convicted of Medicare, Medicaid, or other governmental or private third-party payer program fraud or abuse or required to pay civil money penalties for the same.
(c) I have never been convicted of any criminal felony or misdemeanor relating to the practice of my profession, any other health care related matters, third-party reimbursement, or controlled substance violations.
(d) I have never been excluded or precluded from participation in the Medicare program or any state Medicaid program.
(e) I am able to perform the essential functions of medical staff appointment and clinical privileges in my specialty, and am not presently using any illegal drugs nor any other substance that would impair my ability to perform those essential functions."
At the end of the reappointment application are these statements:
"Any misrepresentation, misstatement, or omission from this application, whether intentional or not, is cause for the immediate cessation of the processing of this application and no further processing shall occur, and my appointment will expire. Upon subsequent discovery of such misrepresentation, misstatement, or omission, my medical staff appointment and clinical privileges may be deemed to be automatically relinquished. In either situation, there shall be no entitlement to any hearing or appeal rights that are contained in the hospital or medical staff bylaws or policies."
Fremont-Rideout Health Group comprises Fremont Medical Center in Marysville, CA, and Rideout Memorial Hospital in Yuba City, CA.
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