Spillin Tea Across America: Kentucky

[00:00:00] Welcome back to Credentialing Chronicles, where we spill the tea on the doctors you see. And we're spilling it baby all across America. Well Nyleen and Shannen's sitting there, talking about you while you pull up a chair. They holding everybody down. And we're back. Welcome back to Credentialing Chronicles. Nyleen, beautiful, how have you been?

[00:00:27] Good. How are you, Shannen? How are your travels going? Oh, you know, just traveling. That's how it'd be. But we're having the best time. It's good that we're doing it in the summertime. Oh, good, good, good. So girl, what state are we in now? Yes, the great beautiful state of Kentucky, where the mountains are long and the rivers are clear. Maybe?

[00:00:54] Yes, yes. We have lots of tea to spill. Because let me tell you, this state, lovely Kentucky. Now I have to confess, I haven't been to Kentucky. I know you drove through Kentucky, right? How was it driving through Kentucky? Beautiful. Just a beautiful state from what I can see. Yeah, I have no experience, honestly. But I'm going to have to take a trip after doing this episode,

[00:01:18] girl. Because listen, we've talked about opioids, right? We've talked about drugs. We've talked about billing fraud. But we're going to start off with a case that isn't just about malpractice. It's actually something a lot darker. We're going to start with, unfortunately, a pediatrician's office and ending in federal prison.

[00:01:42] And honestly, Nailene, when I first read this story, I had to read it twice. Because every once in a while, you know, you come across the healthcare headline and you think there is absolutely no way this is real, Nyleen. And somehow it gets worse and you keep reading it and it gets worse. And you're like, oh my God, I can't even believe that we're about to talk about this on a whole episode. I know. I know. I know. All right. So we're going to take this takes place in Louisville,

[00:02:12] Kentucky. And y'all can correct me if I'm wrong. I think it's Louisville, Louisville, Louisville. Okay. So Louisville, Kentucky, we have a respected doctor, a pediatrician. So we need to make sure our babies are safe. Yes. Setting the scene. Yes. So someone parents obviously trusted with their children. Someone who spent, of course, years building their career, caring for patients.

[00:02:39] Someone whose professional life looked very successful from the outside. Board certified. Well, that's a good thing. All right. Practicing medicine, respected in the community. The type of doctor that you probably would have sailed, right, through most credentialing committees really without much discussion. It sounds like it. It sounds like it. Yeah. You know exactly the file, the one where everybody on the credentialing committee flips through the

[00:03:07] page and say, oh, yeah, this looks real good. This looks real good. Nyleen. Any questions? No. Okay. Okay. Y'all approve. Boop. Exactly. Exactly. And for y'all that don't know, that's literally how it happens. We sit in a committee, we review it. Any flags? No. Keep going. Right. So nothing about this story really begins with an obvious red flag. There's no real giant warning signs, no criminal history, no disciplinary actions, no indication that really federal agents would one day be involved in their life.

[00:03:37] Okay. Come on, Nyleen. I need you to spill the tea, baby. Spill it. Spill the tea. I got the people magazine edition, darling. Okay. So this doctor was involved in a contentious divorce, a custody dispute involving her former husband. Now let's be clear. Divorce itself isn't unusual.

[00:04:00] We've all been divorced maybe a time or two. Maybe a time or two. A couple of husbands. No, no, no, no, no. Healthcare professionals, you know, they get divorced too. Times be tough, people. Look, people are getting divorced. It'd be tough. It'd be tough out there. Right? Not Nyleen all nervous, y'all. Now we're out here making Nyleen. If you've been divorced, hit us down below. Say, I've been divorced too. Let us know you're in the same boat with us.

[00:04:28] I mean, credentialing committees, you know, would never survive if divorce became something to disqualify the providers. I mean, we would be disqualified as well. Exactly. Exactly. But investigators, so what happened is investigators later alleged something happened during a custody dispute. So, you know, with, with marriages and babies involved, there's a lot going on. So something really that moved. Yes. This is something that moved far beyond

[00:04:54] family court, far beyond legal disagreements, far beyond an emotional frustration, right? According to federal prosecutors, the physician began exploring an option. Most people only see in these crime documentaries, which you know, are my favorite, which is girl hiring someone to kill her husband. But it never works. I mean, you know, you see them. Like, do they not watch the movies? Do they not

[00:05:21] watch the movies? There's forensic. The wi-fi towers tell on us. I mean, there's flat cameras now. Like, come on. Okay, but let's pause right there. All right. Because that's where this story goes from healthcare news to Dateline NBC. Yes, girl. So according to these records, the law enforcement became a lawyer. The law enforcement was not aware of the alleged murder for hire discussion. Tell me, tell me.

[00:05:48] FBI became involved. Undercover operation began. I know they did. Girl, conversations were documented. Investigators started building a timeline. And what they allegedly discovered was absolutely shocking. I'm shocked right now. You ain't even said it. So federal prosecutors said the physician was willing to pay substantial money to have her formal husband

[00:06:17] murdered. Not intimidated, not threatened, not followed. Girl, she wanted him offed off. So like, soprano style. Like, I want you to kill him and put a horse in his head. Put a horse head in the bed type of deal. I mean, this is one of those moments where reality feels stranger than fiction, Nyleen. Because when most people hear murder for hire, I mean, I'm imagining mob wives, right? Like,

[00:06:42] this is what they do after they eat the spaghetti, right? But not pediatricians. Mommy, you kill the people in that day. You take care of my babies at night. Like, or you, or you take care of the babies in the day. You kill the people at night. I know, which is why this story really became national news because it shattered all assumptions. People assume dangerous behavior has like a certain look, or you're supposed to be like part of the mafia or like a profile or a certain background.

[00:07:10] But really, healthcare has taught us repeatedly that professional success and personal decision-making really don't always jive together. One doesn't necessarily correlate to the other. Oh my god, a pediatrician out of all the people. I mean, according to the reporting, federal agents, what, conducted an undercover operation as the investigations like had allegations, you know,

[00:07:36] as they investigated all the allegations that was coming up. And so the evidence eventually led to the federal charges, which means that they were finding literal stuff to be able to charge them with. And suddenly the physician wasn't sitting in his, in exam room anymore, looking at little Timmy's leg. She's sitting in federal court, you guys. Like... I know. And think about that transition, Shannon. I mean,

[00:08:02] one minute you're caring for patients, you're a professional, you're wearing your white lab coat, and the next you're the subject of a federal criminal investigation. I mean, that's not a career detour. That's like a career cliff you're falling off of. Exactly. And people don't understand, honey, how far, how fast people fall, right? I mean, that's the true part, you know? I know. And eventually, according to the Department of Justice, the physician ended up pleading guilty.

[00:08:30] Federal prosecutors laid out the facts of the case. The court reviewed the evidence. The sentencing follows. Girl, she got 12 years in federal prison. And you know, what I was thinking about, Nyleen, right now, was the other pediatrician, remember in Iowa with the little girl in Florida? Like, you know, we just put so much trust in the pediatricians, you all. And again, we're going to say this. This is happening in 2026.

[00:08:57] This is not happening five years ago, two years ago. 12 years she got, right? Think about how many physicians spend 12 years becoming physicians, Nyleen. The undergraduate, the medical school, the residency, the fellowship, all to build a career. And then one catastrophic decision changes everything. And you sit in your orange attire. And, you know, let's talk credentialing because, you know, of course, that's our name.

[00:09:23] Because somebody listening is asking like, okay, well, what are we supposed to do about this, right? She wasn't, we weren't talking about clinical competency. We weren't talking about how smart she was or how good she was as a doctor. The answer is probably nothing initially. Yeah, yeah, yeah. I mean, Nyleen, right? And that's the uncomfortable reality. I mean, sometimes people make terrible decisions years after their appointment. Credentialing isn't psychic ability. You know what I'm saying?

[00:09:52] We don't have a crystal ball, right? Correct, correct. No credentialing application is going to go ahead and ask you like, do you intend to hire someone, a hitman for the future, you know? Do you anticipate marriage lasting the next two years? You know, I mean, there could be some questions that we can really put out there, right? Right. And I mean, and if it did, I'm guessing everyone would check what, Nyleen? No. No. No. No.

[00:10:19] Yes, I expect my marriage lasting the next nine reappointments. I know. So what this case does highlight, though, is the importance of ongoing monitoring. Because initial credentialing is only one piece of the puzzle. But organizations, that's why it's so important for them to have a mechanism for that professional conduct reporting, criminal monitoring, medical board surveillance, leadership reporting structures, and behavioral concern escalation.

[00:10:47] And of course, what do you always say, Shannon? And what's the one alert we always got to have? Google alert, baby. Set it on anybody that you're credentialing. And, you know, again, that's where MSPs become critical, you guys. I mean, everybody wants to say that, you know, MSPs aren't critical. They're secretaries. They're sexy. They're so amazing. I mean, they say everything. But that they're critical. Okay? Because sometimes troubling behavior surfaces long, long, long before a criminal indictment.

[00:11:16] And staff, and what does that mean, right? Nadine, let's talk about it. It means staff complaints. Professionalism concerns. It means getting average remarks on your peer references. You start seeing average remarks, you need to call the peer back. I understand that you don't want to. I understand you don't feel comfortable. Hey, this is between me and you. I'm just going to note it confidentially in the credentialing file. But why did you check average? I mean, look at behavioral issues. Oh, my God.

[00:11:46] What about in the OR, the disruptive conduct that you always see, Nyleen? Boundary violations. Oh, you know, that's Dr. So-and-so. He always grabbing booties. No, he shouldn't be grabbing no booties, baby. And really, I think at the end of the day, Nyleen, patterns matter. And they always present before the actual problem. Absolutely. And then one thing I always think about in cases like this is, like, how many people are affected. Obviously, you have the intended victim, her poor ex-husband.

[00:12:16] Well, we don't know what he did. So, you know, I'm going to say borrow. Oh, yeah. We're not going to put them in the court of the public opinion because, you know, men will push. Men will push. We love you sometimes. Okay. But anyway, there's children. There's children involved, right? You got family. You have a community. You have friends, colleagues, staff, patients.

[00:12:43] You know, your entire community that you built so hard to gain a reputation for. And then all of that is just, like, gone. Yeah. And I think that's the thing that, you know, a lot of people forget, right? Healthcare professionals don't exist in a vacuum. You know, it's not like they just every day wake up to be the best healthcare professional in the world. I mean, yes, they do. And I'm sure like we do. We wake up to be the best credentialing, you know, executives in the world, the best compliance people.

[00:13:11] But life takes effect. You know, life is there. Life is lifing. You know, people trust them. People rely on them. People look up to them. Again, life is lifing. And sometimes it's hard being that pillar, you know, which is why stories like this hit differently. Because sometimes, honey, what happens? The pillar falls. You know, the pillar can't hold up all the pressure. You know. Anyway, time for a quick game. Pass the file or fail the file. Are you ready, Nyleen? Yeah, sure.

[00:13:42] A physician has a clean application. No criminal history. You know, like we said. Like you just said, right? Everything checks out. Are you passing it or failing it? Of course, passing the file. Exactly. That's the point. And sometimes there are no visible warning signs. Which is why recredentialing, monitoring, and professional conduct oversight matters so much. And by a human. Not by an algorithm. By a human. Absolutely. Okay, girl.

[00:14:09] Well, if you thought that story was unbelievable, our next Kentucky case may be even more shocking. As it always is. Always. Because, you know, I love my story. You do. You try to up us every time. Because it involves someone who wasn't just a physician. He was involved with physician oversight itself. So, think like CMO level, right? Like somebody who's watching the doctors. Someone entrusted with helping protect the public from dangerous doctors.

[00:14:40] And according to federal prosecutors, he became one of the very people the system was supposed to stop. Coming up, right? Well, that's what we're talking about. The watchdog who became the story. I mean, basically, a former medical board member. You know, he had an opioid investigation. There were several patient deaths. Federal prosecutors were involved, as they always are in Nyleen's stories. And one giant lesson, right? No one is above the law. Or at least we think. Mm-hmm.

[00:15:10] So, you know, we talked about a pediatrician whose life, like you said, took a shocking turn from exam room to federal courtroom, right? But the story may be even more settling. Because this isn't about a physician who quietly practiced medicine. This is about someone who helped oversee physician discipline, like Nyleen stated. You know, what they did was they were supposed to help identify dangerous physicians.

[00:15:37] But according to federal prosecutors, he actually became the one physician under scrutiny himself. Right. You know what makes it so uncomfortable is it's not just the allegations. It's the irony of the whole story. Because when the watchdog becomes the investigation, people start asking whether anyone is then truly being watched. Let's set the stage. We have Kentucky. Opioid epidemic is devastating communities. We know that this was a problem, is a problem, still is a problem.

[00:16:07] Hospitals are dealing with overdoses. Emergency departments are overwhelmed. Families are losing loved ones. Law enforcement agencies are investigating pill mills across the U.S., not just in Kentucky. Federal regulators are paying attention. DEA is like high alert. Healthcare organizations are under increasing pressure to identify prescribing concerns before tragedy strikes. You know, so there's this whole situation going on in the background.

[00:16:36] And this wasn't a secret. I mean, everybody knows this. But by this point, everyone in healthcare knew opioids were under a microscope. I mean, medical boards knew. Hospitals knew. Payers knew. Everybody knew. You know, even the federal government. Exactly. And yet, according to the Department of Justice, federal investigators would eventually focus their attention on a Kentucky doctor who, girl, he had served as the member of the Kentucky Board of Medical Licensure.

[00:17:06] The very organization responsible for the physician oversight. Yeah, giving them licenses. I mean, right? I mean, the role, you know, let's talk about that real quick. The role of the medical board. What that means. Because I know some listeners might not really understand how that plays into it. So the medical board aren't just another committee. Okay. They are the organization responsible for protecting the public. They're reviewing complaints. They're investigating allegations.

[00:17:35] They're monitoring physicians. They're issuing licenses. They also issue discipline. And by doing these and monitoring these functions, they are supposed to be protecting patients. And that's why this story really landed like a bombshell because the public expects the medical board members to represent the highest standard of professional conduct. Like they're going to be held to a different standard. Not perfect, obviously, but definitely accountable. They're going to have leadership. They're going to have professionalism.

[00:18:05] Right. Absolutely. More than anything else. They're going to be, you know, they're going to have integrity. Right. It makes sense. And then, you know, Nyleen, right. When you put someone in that position and they become the subject of a federal investigation, Nyleen, people start asking uncomfortable questions, mama. Exactly. And then according to these federal prosecutors, concerns began emerging regarding the opioid prescribing practices. So let's be careful here because health care providers prescribe controlled substances every day.

[00:18:35] And when I say health care providers, I mean allied health. I mean, you know, nurse practitioners, PAs, doctors, podiatrists, everybody. Right. And many doctors do so appropriately because there's nothing worse than being in pain and not having pain medicine. Many patients genuinely need pain management and pain medicine itself is not the issue. We want everyone to get the appropriate health care that they need. The issue is when then the prescribing patterns become the danger. Yeah.

[00:19:04] And we're really big at talking about data and letting data talk for itself. And that's where data really starts talking because health care leaves footprints, you guys, prescriptions, claims, patient encounters. I mean, pharmacy records. You know, people think that this stuff is done in the dark, but maybe the DEA is watching. There's peer review data. You know, sooner or later, patterns emerge. Right.

[00:19:27] So according to evidence presented at the trial, federal investigators alleged that the physician prescribed opioids outside the usual course of professional practice without a legitimate medical purpose. So, you know what we've talked about. You get a script. You get a script. So the government went ahead, spent years building its case, reviewing the records, interviewing witnesses, analyzing the prescribing patterns, following the evidence. Yeah.

[00:19:55] And that's what I find fascinating. What I find fascinating, mamacita, is these investigations rarely begin with one giant smoking gun, right? I mean, most begin, like you said, with small concerns, one complaint, one patient, one year of investigating, two years of investigating, one pharmacist, one chart. You know, three years of investigating and one question. Exactly. Exactly. Then another and another until investigators start seeing a larger picture.

[00:20:22] So one of the most difficult aspects of this case really involves the human toll, right, that it took. According to the evidence presented during the trial, seven patients later died from these drug-related complications after receiving these opioid prescriptions from the physician. Now, to be clear, those deaths involved obviously complex circumstances that were evaluated through the illegal process.

[00:20:47] But when jurors heard the evidence, it became a central part of the government's case. Oh, I bet. And this is where the story stops being about regulations and it stops being about licenses and it stops being about health care policies.

[00:21:01] Because now we're talking about families, people who expected that their loved ones to come home, people who trusted health care professionals to take care of a broken leg, you know, but really they have gotten their loved one addicted and now there's overdosing happening everywhere. I mean, this leaves people with questions and this is something that is happening and so prevalent all over Kentucky. Exactly. Questions that they may never get an answer to.

[00:21:31] Federal prosecutors argued their case. The defense presented theirs. Witnesses testified. Records were reviewed. Evidence was examined. And eventually, like we know, the jury deliberated. I know. Could you imagine sitting in the courtroom knowing your entire career is being evaluated? I mean, everything, Nyleen, right? Your decisions are being scrutinized. Your reputation hangs like literally in the balance of the hands of somebody else. Years of medical training, years of practice, years of professional standing.

[00:22:01] And suddenly 12 strangers are like deciding your future. Anyway, ultimately, they convicted the physician. The formal medical board member who once participated in physician oversight had become the subject of the oversight himself. Honey, the watchdog became the story, right? And that's what makes this case literally unforgettable. Okay. Let's talk about what MSPs should learn about this because this case has a giant lesson hidden inside of it. Oh, yeah.

[00:22:30] And I think it has several. Like first lesson is no one gets a free pass. Not because they're famous or an influencer or profitable or not even because they sit on the board. Yeah. I mean, I will say what is done in the dark always comes to light. That's my favorite saying, right? Every physician gets reviewed. Every physician gets monitored. Every physician gets evaluated using the same standards. Even in the systems where they have a lottery system, your number comes up. Exactly. Because credentialing isn't just a popularity contest. Really, it's about evidence.

[00:23:00] Patterns, like you said. Exactly. Let's be honest. Every organization has them. The physician who generates enormous revenue is the most popular or has the biggest practice, right? Sometimes they think that they're untouchable. Well, you know, that's what they say, right? Well, that's how they are. You know, that's how that person is. And that's dangerous because the moment we stop asking questions is when we stop protecting patients. I know that's right. Well, let's play our favorite game. You're the MSP.

[00:23:29] A physician sits in your board. They're highly respected. I mean, you have to comment below, right? You have to wherever you're seeing this clip at. You got to comment. They're a huge producer to the hospital. Everyone loves them. And then you start noticing really unusual prescribing trends. What do you do? Hmm. Same thing I do for anyone else, which is follow the process, review the data, maybe notify the appropriate leadership, document the concerns, and then obviously maintain objectivity. Exactly.

[00:23:57] Because the bylaws don't say apply peer review unless the physician is important, right? Well, and if they do say that, well, then you need new bylaws. 100%. 100%, right? Okay.

[00:24:10] So let's just talk real quick practical takeaways because red flags can include unexpected prescribing volumes, repeated pharmacy concerns, patient complaints, multiple malpractice claims, peer review findings, DEA investigations, licensure actions, unexpected mortality trends.

[00:24:29] So all of that clinical data that our nurses are working so hard to compile during the reappointment process really comes together and really needs to be reviewed as we say, as we teach, as part of the reappointment process. When you look at it, really one red flag doesn't automatically mean wrongdoing, right? But multiple red flags, Nyleen? I mean, that's where organizations need to start asking questions. And sometimes they don't want to because it's a doctor.

[00:24:57] It's a great physician, allied health, but ask the questions. Well, what I find most compelling about this story is really that it challenges assumptions because we assume that because this doctor sat on the board, he was safer or he was better. We assume that successful physicians are automatically safer. We assume that people in oversight roles are safer, are the better surgeon, are the better doctor.

[00:25:24] Sometimes they are, but sometimes they really aren't. Yeah, and really that's why good systems matter, right? Because good systems don't depend on personalities. I mean, it doesn't depend on the popularity contest. Good system depends on process and everybody's getting reviewed within that process. Right. So the lesson from Kentucky in this case is very simple. Titles don't replace verification and definitely don't replace the wonderful job we do as MSPs.

[00:25:52] And influence does not replace oversight because reputation does not replace accountability. Yeah, and again, patient safety shouldn't be up for maybe let's not be consistent on it, right? I mean, patient safety requires consistency, no exceptions. Before we go into our next story, let's just take a quick second to talk about our main sponsor, Bataan Health. So it's critical to use a system like Baton Health because they are going to ensure that we can check all of our licenses,

[00:26:22] DA, prescribing, and OIG and SAM all at one time. Now, they are going to add a lot more features, but we want to make sure that you take a minute, go to BataanHealth.com and check out all the resources. And you can do your first 10 doctors for free. So if you're in a small practice, please go to their website and I encourage you to implement this as part of your credentialing practices at your facilities. Bataan Health. Let's go to the next story. Go ahead.

[00:26:52] You start our next story. Okay, let's do it. Our next story takes us deeper into the opioid crisis. It seems like what is really coming out of Kentucky is just a lot of corruption around opioids. I mean, deeper into the questions about prescribing you guys. Deeper into the difficult balance between treating pain and protecting patients. And I'm sorry guys, but unfortunately, deeper into the tragedy. Well, story number two was about accountability at the leadership level.

[00:27:20] Well, this story is about what happens when prescribing decisions become the center of the federal investigation. And for MSPs listening, this story contains some of the most important lessons you're going to hear all season. Get a pen. Yes. So let's go back to the height of the opioid epidemic. Healthcare organizations across America are struggling. Emergency rooms overwhelmed. As we talked about, communities seeing deaths rise. Families losing loved ones.

[00:27:50] But regulators were becoming increasingly concerned about prescribing practices. So now we're actually going to take a minute and say, oh, let's look at the docs. Okay. Well, that's something we need to acknowledge, right? Because pain is real. Chronic pain is even devastating. And many physicians work incredibly hard to help patients suffering every day. Most pain management physicians practice appropriately and ethically. Absolutely. And this isn't an attack on pain medicine, guys.

[00:28:15] This is about what happens when federal investigators believe prescribing practices cross a line. Tell it. Okay. According to the Department of Justice, the Kentucky area anesthesiologist and pain management doctor became the focus of the investigation into opioid prescribing practices. From the outside, he looked successful. Obviously, medical training, had an active license, patients, a full practice. Everything was normal.

[00:28:44] And then if you're listening as an MSP, you're probably credentialed physicians who look exactly like this, right? I mean, nothing immediately jumps off the page. No giant warning labels. There's no flashing lights when you see these type of application. I mean, no application section is even tied to future federal investigation pending. Exactly. Exactly. Which is why the story really becomes important because it reminds us that credentialing isn't only about collecting documents, which is what we scream at the rooftops.

[00:29:13] It's about understanding the risk. I have an entire topic about how we as MSPs are risk mitigators. Anyway, according to federal prosecutors, investigators began examining prescribing patterns associated with this doctor. Now, when the DEA actually starts looking into prescribing data, they aren't looking at just one patient.

[00:29:37] They're looking at overall trends, volumes, patterns, frequency, documentation, and most importantly, medical necessity. Think about healthcare data like footprints in the snow, right? One footprint tells you very little. Thousands of footprints now. You're seeing where the path might lead you. Exactly. Federal investigators reviewed these records.

[00:30:00] They analyzed the prescriptions, interviewed the witnesses, and over time, they went ahead and built a case because one of the most difficult aspects of this case involved allegations connecting prescribing practices to, unfortunately, multiple patient deaths. According to the DOJ records, prosecutors alleged medications prescribed by this doctor resulted in at least five patient deaths. Five families, five stories, five lives.

[00:30:30] And honey, this is where these stories become incredibly difficult because every healthcare chart belongs to what, you guys? A real person. Every medical report represents someone's mother, you all. Someone's son, someone's spouse, someone's friend. And this is why Credentialing Chronicle was brought into existence because we have to talk about this. Exactly. Exactly.

[00:30:53] And while the legal process focuses on evidence and statutes, families are just left carrying out the grief of all of this. Carrying it. Sad, sad, sad, sad. Federal prosecutors ultimately brought charges related to unlawful distribution of controlled substances. Investigators alleged the physician prescribed the medications outside the usual course of professional practice. The case went through the federal court system. Evidence was presented. Witnesses were called.

[00:31:23] Arguments were made, girl. I bet they were. And here's something really that MSP should understand. By the time a federal opioid case reaches this stage, investigators have typically spent years gathering evidence, you all. These cases don't happen overnight. I mean, they are working, honey. Exactly. Which raises an important question. How many opportunities existed for intervention before federal prosecutors arrived? Tell me about what happened. How were they sentenced? I need to know.

[00:31:53] So, well, ultimately, according to the Department of Justice, the physician was sentenced to a hundred months in prison. He agreed to forfeit his medical license. Restitution was ordered. And a medical career that took decades to build ended completely in this federal courtroom. I know. That's what we always think about, right? Years of education, training, years of practice. I mean, it's all gone. You know, the trust is all gone. And that's why peer review and credentialing matter.

[00:32:23] Because think about when or how soon this could have been caught or, like, alerted to the doctor, right? Because patient safety failures don't just impact one patient. It destroys careers. It destroyed this doctor's livelihood, practices. And then it destroyed families, entire organizations, trust in a community. And it's just horrible. Yeah. I mean, let's talk about the question every, you know, medical staff profession is literally asking, Nyleen, right now. Could credentialing have stopped this, right?

[00:32:53] Well, I guess the actual sense of the word is not necessarily because as credentialers, we don't see how many prescriptions are written. We don't necessarily audit medical records. And that's the honest answer and the scary answer for a patient. Credentialing alone cannot prevent every future problem.

[00:33:12] But credentialing may be combined with an OPPE or an FPPE, a good peer review, a good quality review, a documentation review, controlled substance monitoring, and then medical staff leadership and oversight. Maybe those systems together can really identify patterns to control and maybe stop it earlier. So let's talk a little bit about red flags because sometimes warning signs are subtle. Sometimes they're not.

[00:33:38] For example, like a repeated patient complaint or maybe like the same patient coming back, you know, and prescriptions and overly prescriptions. Like, you know what the average prescription is, right? Maybe mortality reviews. Are your patients dying at an alarming more rate, you know, or documentation deficiencies? You notice maybe things aren't being completed on time. I don't know. What do you think? Yeah. I mean, I think, you know, like you said, the patterns, the monitoring, the, you know,

[00:34:06] the credentialing combined with the OPPE, the FPPE, I mean, and listening to patients complain. You know, if there's a patient complaint, people need to listen. One complaint is really not a lot. Ten complaints, you know, hey, now we're starting to look at a pattern. Mm-hmm. Patterns, outcomes, complications, utilization rates, peer review findings, patient complaints. All those pieces together are going to paint a picture.

[00:34:36] Yeah. OPPE is a great tool that tells a story. You know, it's not a genetic story. It's a data story. I mean, it's really the story of what the provider's been doing, you know? Mm-hmm. All right, Shannon, how about you spill a little peer review tea? One of the biggest mistakes organizations makes is treating peer review like punishment, right? Oh, that's a good one because peer review isn't supposed to be punishment. It's really supposed to be protection. Yes, definitely. Exactly.

[00:35:05] Protection for patients, protections for physicians, and protections for the organization. And then when peer review becomes political or inconsistent or selective, doesn't everybody lose? Well, we've definitely seen cases like that coming out of several states where peer review has been used as a weapon. You know, but I guess it would be time for another round of what would you do? Okay. So you're the MSP. A physician has privileges.

[00:35:35] No sanctions. No board action. Again, just great, right? Then for pharmacy, you know, they say that concerns start to appear. Patient complaints start to increase. And questions about prescribing begin surfacing. What would you do? Document it, I guess. And then maybe escalate. Follow policy. Involve leadership. Initiate a review. Most importantly, remain objective.

[00:36:04] Notice what she didn't say. Ignore it because the physician is profitable. And that's what a lot of organizations wind up doing. Exactly. Because the bylaws don't contain a profitability exemption, of course. Exactly. Exactly. So the biggest lesson from this case is simple. Patient safety requires vigilance, right? Not because we assume bad intentions, but because healthcare is very complex. And risk often reveals itself gradually.

[00:36:34] Yeah. I mean, I rarely think that somebody wakes up and says that they want to be a headline on credentialing chronicles. I don't think so. I don't think they want to do that, no. No. I mean, really, you know, there are always warning signs, right? There's patterns. There's questions. There's concerns. And they're always there before the actual reason they're on credentialing chronicles exists. Right. And the challenge is really whether or not anybody's actually paying attention. Yeah. Yeah. That's the biggest thing I think that we have to take away.

[00:37:04] I mean, what do you think for MSPs? You want to do a little PSV for them? Well, I think that we need to look at OPPE. What is OPPE? How does it matter? How does it relate to our reappointment cycle? How do we explain peer review to the peer review team to tell them how much it matters? And then DEA verification matters, guys. Quality monitoring matters. This ongoing management that we have, we should be doing an automatic check every 30 days.

[00:37:33] The state of Georgia has a thing called PDMP where the doctor has to register and we get flags every time we prescribe an opiate for a patient. So we get a full report. So if you work in a doctor's office, make sure you're checking that if you're the medical assistant or if you're the nurse in an office. Make sure you are reviewing that with your physicians and we're not over prescribing for our patients. Yeah.

[00:37:56] And I would say also, I would also say too, if you're in a high risk state for opioid misuse, you know, maybe tracking prescribing habits. You know, if your state, it doesn't independently have a program for that. But, you know, if you could pull reports from pharmacy and different things of that nature, because, you know, I guess the high risk states is where it really, you know, comes out. Well, for physicians, good documentation protects everyone, right?

[00:38:22] Don't be writing no prescriptions for people that you are not assessing and diagnosing. That is the number one cause for physicians getting in trouble. Mm-hmm. And for organizations and self-consistency matters. Apply the same standard for everyone and make sure your policies and procedures are correct and are appropriately followed every time. So what have we learned from Kentucky? The hills, the mountains got some opioid problems. Okay.

[00:38:50] The mountains got the opioid problems. All right. Right. And I, I mean, right? Yeah. And, you know, a lot of the states, we've seen a lot of fraud. We've seen a lot of billing. But we really haven't seen too much. We haven't talked too much about, you know, bad prescribing practices and how much it can cause actual patient harm. And so another level for MSP is another reason why we are so valuable to an organization.

[00:39:16] And I love that we talked a little bit about, you know, OPBE and how ongoing monitoring is just critical to any organization. And that it's actually a good thing because maybe, you know what, that doctor could have been alerted and said, hey, doc, you know, just take a look. Don't do X, Y, Z. And could have avoided him, you know, 100 months in prison. 100%. I mean, really. And doctors should really be looking at MSPs as their, you know, compliance gem in their pocket. Mm-hmm. Mm-hmm. Okay, guys.

[00:39:45] Oh, I was going to say, make sure you comment, follow, subscribe, right? Mm-hmm. And stay credentialed. And not canceled. Not canceled, baby. Until next, until the next date. Ooh, Shannon, that was a lot of tea. Honey. But have they subscribed yet to hear it next week? On all of these platforms, please subscribe, like, and follow us. Bye. Bye.