Credentialing Scams: How to Protect Your Healthcare Business
Today, I want to get real about something incredibly important—a scam alert. Specifically, we’re diving into the murky waters of credentialing scams. If you’re in healthcare, you know credentialing is vital for billing insurance companies and keeping your practice afloat.
But here’s the kicker: so many providers are getting scammed by unreliable credentialing companies.
I’ve been hearing from folks left and right who’ve paid big bucks upfront to credentialing services that just didn’t deliver. They took the money, failed to do their jobs, and left providers hanging, waiting endlessly to be credentialed with insurance companies. It’s heartbreaking and costing people time, money, and sometimes their businesses.
Key Takeaways:
- Credentialing scams target healthcare providers with high costs and false promises.
- Always vet companies by checking references, reviews, and the BBB.
- Avoid paying the full upfront—opt for installment plans for added security.
- Stay involved in the process by requesting regular updates and proof of progress.
- Use credit cards for payments to benefit from fraud protection and dispute options.
Why Credentialing Scams Are On the Rise
Let’s face it: the medical field isn’t exempt from scammers. More private practices are popping up, and the demand for credentialing services is sky-high. Unfortunately, some shady players see this as an opportunity to capitalize on your need—and sometimes your desperation.
Credentialing is an expensive and necessary process. It’s also one that requires you to trust the company you hire. That’s why you must vet every vendor you bring into your business.
Red Flags to Watch For in Credentialing Companies
If you’re hiring someone to handle your credentialing, there are specific warning signs you need to look out for. This is your business and livelihood, and it’s okay to ask questions and demand transparency.
Here’s what you need to do:
- Ask for References
Any legitimate credentialing company should be able to provide references from other providers. Don’t stop there—call those references. Ask them in-depth questions:- Did the company deliver on time?
- Were there any hidden costs?
- How was their communication throughout the process?
- Check the Better Business Bureau (BBB)
The BBB website is a goldmine of information. Look up the company name, check their ratings, and read customer reviews. If there are complaints, see how they were handled. - Understand Payment Terms
Credentialing services are pricey, but that doesn’t mean you should fork over the entire payment upfront. If a company insists on full prepayment, consider that a red flag. Ask about installment options and how they prioritize their workflow.
Pro Tip: Protect Yourself When Paying for Credentialing Services
When paying for a credentialing service, use a credit card instead of a debit card or check. Here’s why:
| Payment Method | Why It’s Safer |
|---|---|
| Credit Card | Many credit cards offer protection against fraud. You can dispute the charge and get your money back if you get scammed. |
| Debit Card/ACH | Many credit cards offer protection against fraud. If you get scammed, you can dispute the charge and get your money back. |
| Checks | Gives the company your personal banking information—not ideal. |
Never give out your bank account information or share your checking account details unless necessary. This usually isn’t required in the credentialing process until you’re officially contracted with insurance companies.
Ask the Right Questions to Protect Your Business
I can’t stress this enough: you must come to the table informed. When interviewing credentialing companies, don’t be afraid to ask hard-hitting questions. At the same time, you want to strike the right tone—assertive, not accusatory.
Here’s what to ask:
- What’s your workflow like? How do you prioritize clients, and how long does the process usually take?
- Can I get regular updates? Regular communication is key. Make sure they understand that you expect routine progress reports.
- What happens if there are delays? This question helps you gauge their accountability.
Being informed puts you in a position of strength. It lets the company know you’re serious, knowledgeable, and won’t be taken advantage of.
Don’t Hand Over Control—Stay Involved
Here’s one of the biggest mistakes I see: providers hire someone for credentialing and then completely exit the process.
Do not do this.
This is your business, and you have every right to stay involved. Monitor their progress, ask for updates, and follow up regularly. It’s your responsibility to ensure the job gets done.
How to Thoroughly Vet Credentialing Companies
You can’t afford to cut corners when you’re looking for a credentialing company. A bad hire here could mean losing thousands of dollars, delayed insurance contracts, and endless frustration. The goal is to find a company that’s reliable, trustworthy, and transparent—and here’s how to do that effectively:
1. Look for Signs of Transparency
A credible credentialing company should be open about its processes and policies. If it hesitates to provide answers or brushes off your questions, that’s a huge red flag.
Here are a few specific things to ask for:
- Workflows and Timelines
What does their process look like from start to finish? A solid company will be able to explain step-by-step how they handle your credentialing and give you a clear timeline for completion. - Client Contracts
Always, always request a formal contract that outlines the scope of work, deadlines, payment terms, and refund policies. If they refuse to provide one, run. - Regular Updates
Ask how often they’ll communicate with you. Will you get weekly updates? Bi-weekly? Set the expectation upfront so you know when to follow up.
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2. Pay Attention to Customer Reviews
Reviews are your secret weapon when it comes to avoiding credentialing scams. Here’s how to dig into the company’s reputation:
- Better Business Bureau (BBB)
The BBB is your first stop. Look for any unresolved complaints or patterns of negative reviews. A low rating is a major warning sign. - Google Reviews and Other Platforms
Don’t stop at BBB—check Google Reviews, Facebook, and LinkedIn. Are clients praising the company’s professionalism and reliability? Or are you seeing repeated mentions of delays and missed promises? - Ask for Direct References
A trustworthy company won’t hesitate to give you references. When you call their current or past clients, ask questions like:- Did they meet deadlines?
- Was communication clear and consistent?
- Were there any unexpected fees?
Pro tip: Don’t just trust written testimonials. Call references and ask for real feedback.
3. Protect Your Payments—Don’t Get Burned
Let’s talk about money because this is where many providers get scammed. Credentialing is often expensive, and scammers love to take advantage of this.
The Smartest Payment Strategies:
- Use a Credit Card
Credit cards often have fraud protection. If something goes wrong, you can dispute the charge and get your money back. - Avoid Direct Bank Transfers
Never hand over your checking account details or allow ACH withdrawals. A legitimate company won’t require this upfront. - Installment Payments
Request a payment plan instead of paying the full amount upfront. This ensures the company is incentivized to complete the work on time.
| Payment Option | Risk Level | Why |
|---|---|---|
| Credit Card | Low | Fraud protection and dispute options. |
| Debit Card/ACH | High | Direct access to your bank account. |
| Installment Plan | Low/Moderate | Reduces upfront risk. |
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4. Be Assertive—This Is Your Business
When vetting a credentialing company, it’s critical to show that you’re informed and involved. This isn’t about interrogating them—it’s about setting expectations.
Here’s the tone you want to strike:
- Firm but Professional
Be confident when asking questions. You’re not being a “difficult client”—you’re protecting your business. - Clear About Your Expectations
Let them know you expect transparency, regular updates, and accountability throughout the process. - Stay Engaged
Don’t just hand over the process and assume everything will go smoothly. Check in regularly, ask for updates, and make sure they’re on track.
Common Credentialing Scams to Avoid
By now, you know the red flags and steps to protect yourself—but let’s quickly cover a few specific scams that are cropping up more and more:
1. The “Pay Everything Upfront” Scam
Scammers demand full payment upfront, disappearing or delaying endlessly without delivering results. Solution: Always request installment plans.
2. The “Bank Info Grab” Scam
Some shady companies insist on ACH transfers or checking account info “for faster payment.” Once they have your details, you’re at risk for fraud. Solution: Pay with a credit card instead.
3. The “Fake Progress” Scam
These companies send vague updates but never actually file your credentialing paperwork. Solution: Ask for proof of submission (like confirmation emails or documentation).
FAQ
What are credentialing scams, and why are they rising?
Credentialing scams occur when companies promise to handle insurance credentialing but fail to deliver. The rise is due to increasing demand for credentialing services as private practices grow, making it a lucrative target for scammers preying on trust and desperation.
How can I identify a credentialing scam?
Look for red flags like full upfront payments, refusal to provide references, vague timelines, and requests for sensitive banking information. Legitimate companies should provide clear workflows, regular updates, and client references you can contact directly.
Why is paying with a credit card safer for credentialing services?
Credit cards protect against fraud, allowing you to dispute unauthorized or incomplete services. Unlike bank transfers or checks, credit cards add a layer of security, ensuring you can recover funds if scammed.
What questions should I ask before hiring a credentialing company?
Ask about their workflow, timelines, and communication frequency. To protect yourself, request references, proof of submission for paperwork, and formal contracts outlining payment terms, deadlines, and refund policies.
How do I stay involved in the credentialing process?
Monitor the company’s progress, request regular updates, and request proof of work, such as confirmation emails. Staying engaged ensures accountability and reduces the risk of delays or fraud.
What are the most common credentialing scams to avoid?
Common scams include demanding full payment upfront, insisting on bank transfers, and providing fake progress updates without real results. Always verify claims, request installment options, and use credit cards for payments.
How can I verify a credentialing company’s reputation?
Check the Better Business Bureau (BBB), Google Reviews, and LinkedIn for ratings and customer feedback. Contact direct references to confirm the company’s reliability, deadlines, and transparency.
What should I include in a contract with a credentialing company?
Ensure the contract outlines the scope of work, payment terms, timelines, and refund policies. A formal agreement protects you if the company fails to meet its obligations.
Why should I avoid paying the full amount upfront for credentialing?
Paying everything upfront increases your risk of losing money if the company fails to deliver. Opt for installment payments, incentivizing the company to complete the work as promised.
How can I protect my bank information during the credentialing process?
Never share your checking account details or allow ACH withdrawals. Use a credit card for payments, and only share sensitive information when officially contracted with insurance companies.
Final Thoughts: Protect Your Business
I know this topic isn’t fun, but it’s so important. Credentialing scams are real, and they hurt hard-working providers every day. You can avoid these traps by staying informed, asking the right questions, and protecting your payments.