Why Medical Travel Coordinators Must Independently Verify Physicians' and Dentists' Credentials & Qualifications by Primary Source Verification

In a nutshell, the reason why medical travel coordinators must independently verify credentials, training, experience and other qualifications and competency is that without it, the practitioners are merely strangers in a strange land with the opportunity to hold positions they are not qualified to hold placing patients’ well-being and lives at risk. 

To alleviate such risks, medical travel coordinator best practices include a robust vetting process using “primary sources” to verify certain credentials, including medical school diplomas, specialty training or residency certificates, licenses to practice, malpractice history (complaints, verdicts, and settled matters in all locations and jurisdictions where they have worked; not just their current post), registration with a medical or dental council or any other credential required by law, regulation or hospital policy, as well as any credentials issued by recognized education or professional entities as the basis for clinical privileges.

Contrary to popular myths and misassumptions, neither The Joint Commission nor its international counterpart (JCI) requires other verifications, such as professional history, letters of recommendation, criminal background checks, identification verification, immigration and financial documents to be verified from the primary source, unless required by hospital policy.

The preview of the online application for we use for Mercury Healthcare International medical and dental tourism provider networks is available to see what's involved by clicking the box above. While they may seem "intrusive" to a novice or a practitioner outside the USA, know that this application format is very typical of the US standards for all doctors, dentists, therapists, nurse practitioners, physician assistants, and other care team members. If you cannot or refuse to complete the application, you cannot apply to become a provider. It is as simple as that. But the application is only the first step. Once the information and all related accompanying documentation has been submitted, it must be painstakingly verified.

This involves internal costs and pass through costs. Many issuing bodies charge a small fee for the labor involved in verifying credentials and privileges. The medical travel coordinator or someone hired by them must process the information and adhere to security and privacy regulations for both professional conduct and data storage. Insurance must be in force to cover a breach. The cost to outsource this labor and the fees is generally USD $149-$225 USD per provider if the medical travel coordinator will not do this work themselves, plus the verification costs assessed by the primary sources. Much of the data must all be reverified every 2-3 years depending on quality management system policy and protocols.

Primary source verification means that the individual’s reported credentials and qualifications are verified through the original organization or governmental entity that issued the document or credential, or through a designated equivalent source (i.e. an approved agent of the source that has been determined to maintain specific items of credential information that are identical to the information at the primary source).

Methods for conducting primary source verification include direct correspondence with the issuing source, such as through a documented telephone conversation or by facsimile, email or letter. It is critically important to further ensure that the organization being contacted is a legitimate, accredited organization.

It is important to note that obtaining original documents is not necessarily equivalent to primary source verification – any communication from or with the original source that is through a person who is the applicant or his or her agent is unacceptable as primary source verification.

So often, medical travel coordinators make assumptions of facts not in evidence by accepting doctors and other healthcare delivery team members who will "lay hands" on their clients or make medical decisions and diagnoses (patholologists, radiologists, intensivists, hospitalists, anesthesiologists, and others). They make risky reliances that the hospital credentialing and privileging department has verified "everything" and subject their clients to risks as a the result of insufficient fact-checking, lack of periodic updates, and more.

Many of the medical travel coordinators I coach and train how do "be" an independent professional medical travel facilitator or coordinator have never given this "duty of care" much thought, and haven't a clue as to how one would go about it. In tort law, a duty of care is a legal obligation which is imposed on an individual (a medical travel facilitator, or other medical travel coordinator) requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. It is the first element that must be established to proceed with an action in negligence - against the facilitator or coordinator, not the practitioner.

Why?

Because the independent medical travel coordinator is holding him/herself out as a professional who will be compensated by someone (the patient/client to whom the professional owes fiduciary loyalty, the hospital or clinic paying a kickback or splitting professional fees from the proceeds of a medical service fee paid as compensation for a referral or paid positioning on a medical travel coordinator's short list of professional candidates to whom the independent medical travel coordinator will direct clients.)

So often, independent medical travel coordinators I train start off with the belief that because they place DISCLAIMERS all over their engagement agreements with patients that state that the patient is responsible for their choice of provider, facility and destination. After ten minutes with me on this topic, they quickly realize that no disclaimer they include in any contract protects them against a complaint of professional negligence for lack of credentials and qualifications and competency verification.

Let me try to explain the issue using chicken or egg comparison:

As an independent, professional medical travel coordinator (one with a website who advertises that they offer this service to the public as their "product" so to speak) they initially prepare to do business with the public by first impaneling a network of practitioners and clinics they "believe" are competent, qualified and reliable to deliver said services to the independent, professional medical travel coordinator's clients seeking such services. From this network of panel of practitioners and health facilities, hotels, destination coordinators, drivers and ground transfer service providers, etc., they then develop a website and begin promoting through marketing, advertising, blogging, public relations and other activities, their newly created "brand". Without these two initial steps, there is no business, there are no clients. Right?

The representation of the independent professional medical travel coordinator gives the appearance to a third-party observer that a relationship between two parties (coordinator and provider) creates an agency. For example, the surgeons, dentists or other practitioner or health facility that may be selected and/or "represented" by the independent professional medical travel coordinator as a network provider, may be deemed the “ostensible agent” of the practitioner or health facility by the client. When the independent medical travel coordinator features or otherwise lists the practitioner or facility on their website, they create the presumption of "agency" which leads the client to presume that there is an existence of an agency and the independent medical travel coordinator may be bound by the acts of the agent performed on the recommendation or guidance or services made available through the medical travel coordinator. This is especially true if the patient doesn't directly engage in a business transaction directly with the provider.

In the case of kickbacks, fee splits, and any commission payments, since the independent medical travel coordinator layers him/herself in as an intermediary, the agency relationship is further supported as a reasonable presumption that in order to get into the independent medical travel coordinator's panel, that the vetting was done - and done properly. Partnership by estoppel is created by the giving of an appearance of representation or agency. Without this there is no business, no website, nothing to refer, no one to refer to. Therefore the risk of liability is present before the client ever signs an agreement with a disclaimer in it, the same as if the independent medical travel coordinator might create a box of corn flakes that has toxic substances or spoiled ingredients in it and be liable for what's in the box before it is shipped to the corner grocery store for the grocery customer to chose said corn flakes over other brands on offer. The duty of care is very different from the standard of care. The duty of care is the responsibility or the legal obligation of a person or business to avoid preventable oversights by acts or omissions likely to cause or otherwise risk harm to others.

This duty of care is what I explain to my independent medical travel coordinator students and clients is why disclaimers won't help them defend against what they incorrectly assumed would save them from professional liability for their own acts or omissions. The template contracts I provide them include an "Each responsible for own acts" provision which explains in the contract that the client will sign and that the practitioner or facility will sign that limits "liability by contract" for the acts of the other, but does not absolve them from blame for a fault or wrongdoing as a part of their professional obligation or duty of care.

Finally, you are going to learn what I did when I was actively working as a professional medical tourism coordinator: Just how costly and time consuming the job of primary source verification is. This is where most of my students and clients "jump off" of their idea to become a medical tourism facilitator occurs. They find themselves unprepared, undertrained, and undercapitalized to conduct primary source verification as a start up business. Sorry, that's the job and the business you have entered. You cannot mow lawns for a living without a lawnmower or work as a butcher without knives and tools. You can start a medical tourism facilitator/coordinator business with a website and a cell phone after a few B2B meetings at an industry event, but you leave yourself wide open to risk of professional liability for duty of care and worse...you expose others (clients) to avoidable risk of harm.

And heaven help those who paid a lot of money for some worthless "certification" that creates even greater liability for ostensible agency risk exposure. Giving the public the appearance of professionalism supports the reasonable expectation that, as a professional, you took every precaution in carrying out your professional duty of care. Start advertising that you are certified and dig a bigger hole for yourself in this bottomless pit of liability and agency by estoppel. And, if you didn't perform proper credentials and background verification, it is highly unlikely that any insurance underwriter will insure this risk for you if something goes wrong. And the brand scandal that will arise if you are involved in a mishap or an alleged misadventure that results in litigation? Will you be liable to the provider or the facility for the damage to their brand as a your partner and agency representative? Now you begin to see why I used the term "bottomless pit of liability". Once things go sideways, there's no limit to how much you may be responsible because of your dereliction of duty. Advertise that you are "certified" and then act or omit reasonable standards of practice and you might even be held liable for "false advertising" or "unjust enrichment" or "fraud" because you advertised the "certification" for the purpose of enjoying a competitive advantage over those who are not certified when you did not carry out the duties and responsibilities of a professional that is genuinely certified. And, there's a good likelihood that an expert witness like me will be testifying what a reasonable expectation and practice and protocol looks like regardless of certification in a legal proceeding.

Want to learn more about this? Plan to attend the Medical Tourism Professional's Fly in being held in December 2018. Click the image below to learn more about the agenda and travel details.