Credentialing Chronicles

Special Series | Who Audits the Auditor?

Shannen and Nyleen Season 2 Episode 30

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Special Series | Who Audits the Auditor?

We've sat behind these microphones breaking down healthcare fraud, credentialing failures, compliance mistakes, and the lessons organizations can learn from them.

This time... the file is ours.

In this special series, the roles are reversed as AQC President Shannen opens the door to one of the hardest conversations of her career following an NCQA survey that changed everything.

What happens when the person who audits everyone else has to sit in the hot seat? How do you tell your clients? Your staff? Yourself? And what's the difference between knowing something happened... and actually being able to prove it?

This isn't a redemption story. It's a real-time look at leadership, accountability, credentialing, documentation, and what it takes to rebuild when every decision is under a microscope.

Along the way, we unpack:

☕ The four findings that changed everything.

☕ Why documentation—not assumptions—can make or break an accreditation.

☕ The cost of one missed submission.

☕ Leadership, transparency, and what happens after the audit ends.

No client files. No sugarcoating. No edited version of the truth.

Just one organization choosing to share the journey while it's still unfolding.

This is only the beginning. The outcome hasn't been written yet... and neither has the next chapter.

🎧 Listen now, and follow along as this story continues to unfold—because sometimes the biggest lesson isn't in the audit itself... it's in what happens next. 

Support the show

Resources Mentioned:

🔎 Verify Your Doctor’s Credentials


✔️ State-Specific Medical Board License Lookup:
Find your state’s board here:
https://www.fsmb.org/contact-a-state-medical-board/

✔️ Medicare Exclusions List (LEIE) – Check if your provider is federally excluded:
https://oig.hhs.gov/exclusions/exclusions_list.asp

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

For Medical Staff Professional: 

✔️ FSMB.org – Federation of State Medical Boards Physician Lookup:
https://www.fsmb.org/physician-license-lookup/

✔️ Hospital Websites:
Many hospitals have public directories listing credentialed medical staff. Look for a “Find a Doctor” or “Medical Staff Directory” page.

✔️ Set Google Alerts on Your Doctor’s Name:
Create your own Google Alert here:
https://www.google.com/alerts

 Wanna know if your plastic surgeon is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Open Payments

openpaymentsdata.cms.gov

Verify your Nurses' Credentials: 

https://www.nursys.com/

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