Send us a text

Behavioral health is booming—but billing it wrong can break your practice. In this episode, Shannen and Nyleen unpack the growing wave of medical groups adding therapy, psychiatry, and counseling services—only to stumble into denials, audits, and compliance nightmares.

From the basics of CPT codes and payer carve-outs, to the credentialing pitfalls that practices overlook, this episode digs into:

• What behavioral health billing really means (and why it isn’t just “a few extra codes”).
• Why urgent cares, OB/GYNs, and pain clinics keep adding BH services—and the dangerous shortcuts they take.
• Red flags that trigger payer audits, clawbacks, and fraud allegations.
• Real-world mistakes: upcoding, wrong NPIs, and billing under the wrong taxonomy.
• A step-by-step breakdown of how to credential, enroll, and bill correctly.
• The compliance mindset that keeps paperwork from turning into panic.

💡 Whether you’re a provider, a biller, or a practice administrator, this episode is your survival guide to adding behavioral health services the right way—without setting off alarms.

Takeaway: Adding behavioral health can transform care, but if you cut corners, it will catch up to you. Audit early, credential properly, and protect your providers, your patients, and your practice.

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

Behind the Scenes at Credentialing Chronicles

This week, we’re pulling back the curtain with a special retreat recap! 

Shannen and Nyleen sat down after their Credentialing Chronicles getaway to share:
✨ The big news — we’re headed to NAMSS in the big pink tent!
✨ How YOU can record live with us (no prep needed — just fun prompts).
✨ The power of MSP voices and why your stories matter.
✨ Our ask: more engagement, shares, and feedback to help this community grow.
✨ And yes… tales of waterfalls, trail mix, and lots of brainstorming.

This one’s for our loyal listeners, our fellow MSPs, and everyone who’s been asking, “How can I be part of the podcast?”

Hit play, stay credentialed, and we’ll see you at NAMSS! 💕

Sign up here!

https://calendly.com/credentialing-credentialingchronicles/10

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

Charts to Cellblocks dives into the 2025 National Health Care Fraud Takedown:

• 324 defendants.
• $14.6 billion in fraud.
• And scams so wild, you’ll question if you’re watching Netflix or the nightly news.

From international crime syndicates running billion-dollar ghost claims, to AI deepfake voice scams stealing Medicare millions, to opioid pill mills and fake wound care schemes — Shannen and Nyleen spill the tea on how the FBI, DEA, and Big Data brought them down.

Plus, don’t miss our PSA segment with warnings for patients, providers, and credentialing professionals.

Visit our website for more information: 

www.CredentialingChronicles.com

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

A Florida woman treated over 4,400 patients — all without a nursing license. How? She slipped through the cracks using someone else’s license number, blending in with scrubs, and almost got promoted before HR finally noticed.

In this episode, Shannen and Nyleen spill the tea on how it happened, why credentialing and primary source verification (PSV) matter, and what hospitals and HR can learn from this scandal. They also revisit the fake diploma scheme that put thousands of unqualified “nurses” into hospitals across the U.S.

This isn’t just gossip—it’s a wake-up call. Patient safety depends on rigorous credentialing, audits, and stopping “trust-the-badge” culture before it lands your organization in the headlines.

🔗 Receipts, sources, and resources are linked in the show notes.
 👂 Listen now and stay credentialed, not canceled.

Verify your Nurses' Credentials: 

https://www.nursys.com/

Operation Nightingale: 

https://oig.hhs.gov/newsroom/media-materials/nightingale/

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

NCQA Said Nope – CVO Edition
When NCQA says “no,” they mean no. In this brutally honest, laugh-out-loud episode, Shannen and Nyleen pull back the curtain on Credentialing Verification Organizations (CVOs) — the certified, the expired, the denied, and the ones hiding behind the term “NCQA aligned.”

From decoding NCQA statuses to real-life horror stories of outsourcing gone wrong, they’ll give you the insider checklist to vet your vendors, avoid audit nightmares, and protect your reputation. Whether you’re a credentialing pro, a health plan exec, or just curious about who’s verifying your providers, this episode is your wake-up call.

Edgy. Fun. Real. And yes, there’s plenty of tea.

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

Hey Credentialing Fam 👋,

This one? Whew. It's for you. The backbone. The gatekeepers. The spreadsheet warriors. The unsung compliance pros who hold entire healthcare systems together.

It’s bold, real, and packed with truth bombs about what it actually means to be a Medical Staff Professional today.

Shannen and Nyleen get real about:

* The origin of MSPs as gatekeepers—why it mattered then, and still matters now
* Why credentialing isn’t clerical—it’s clinical, legal, operational, and strategic
* The federal oversight coming in 2028 (yep, the Death Master File is no joke)
* What leadership needs to hear about respecting the credentialing role
* Honest advice for every burned-out, overlooked, and underpaid MSP
* And a big reminder: *you’re not just pushing paper—you’re protecting lives*

*This episode is for the ones who:
   * Answer the call when an audit hits
   * Catch the expired license before it slips through
   * Are tired of being last to know, first to blame
   * Want change, recognition, and a seat at the table

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

When the auditors showed up… some healthcare facilities folded faster than a paper gown.

In this no-chill episode of Credentialing Chronicles, Shannen and Nyleen take you inside real cases where audits uncovered:
✔️ $61 million in fake Medicare claims
✔️ Genetic testing schemes with global players
✔️ Patient safety disasters
✔️ HIPAA nightmares (we’re talking 300,000+ exposed records 😱)

And yes—someone really tried to hide felony convictions with fake nominee owners.

Plus:
 💡 How to check the OIG Exclusions List and SAM.gov
💥 PSA tips for patients, providers, and credentialing pros
📢 “Trust is earned. Licensure is verified.”

FOR OIG VERIFICATIONS: 

https://exclusions.oig.hhs.gov/

FOR SAM VERIFICATIONS: 

https://sam.gov/search/?index=_all&page=1&sort=modifiedDate&pageSize=25&sfm%5Bstatus%5D%5Bis_active%5D=true&sfm%5BsimpleSearch%5D%5BkeywordRadio%5D=ALL

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

Cut for Cash – Hospital Indicted
Scalpel. Silence. $400 Million Lies.

What happens when a hospital knows a surgeon is performing unnecessary sterilizations, forging delivery dates, and submitting fake Medicaid paperwork—
…and keeps renewing his privileges anyway?

What happens when that same hospital is accused of profiting from it?

Answer: A federal indictment.
Yes. An entire hospital system criminally charged.

🧾 Credentialing failures.
💰 Kickback schemes.
📉 Compliance culture in flames.

This week on Credentialing Chronicles with Shannen and Nyleen, we unpack:
🔹 A physician with prior felony convictions—and a 35-year credentialing pass
🔹 A surgical side hustle that became a criminal enterprise
🔹 $400M in illegal Medicaid referrals masked as “community outreach”
🔹 And why the DOJ is done playing nice with hospitals who “look the other way”

💡 If you work in medical staff services, compliance, healthcare leadership—or if you just like the sound of court drama with clinical consequences—this one’s for you.

🛑 Credentialing isn’t just paperwork.
It’s your hospital’s first and last defense against a federal indictment.


#CredentialingChronicles #HealthcareFraud #MedicalStaffServices #ComplianceMatters #HospitalIndictment #MedicaidFraud #CredentialingFailures #MSPstrong #HealthcareLeadership

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

Medicare & Medicaid Fraud Exposed

When trusted credentials become criminal tools, the stakes are higher than malpractice insurance. In this episode, Shannen and Nyleen pull back the curtain on real-life cases where physicians and healthcare professionals used their white coats for cold cash — leaving Medicare, Medicaid, and patient trust in the dust.

From a Texas doctor selling signatures for $30 a piece, to COVID-era cancer scams in New York, to a $160 million pharmacy empire crumbling in Houston — we cover it all, Fraudpalooza-style.

🔥 Juicy stories.
⚠ Real consequences.
💡 Credentialing lessons you can’t afford to ignore.

If you work in healthcare, compliance, billing, or credentialing — you’ll want to hear this one.

Listen now wherever you get your podcasts. And as always: Stay credentialed. Stay skeptical. Stay safe.

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....

Send us a text

What happens when hospitals stay silent, and the cost of that silence is $400 million—and patient lives?

In this explosive episode of Credentialing Chronicles, we dissect one of the most disturbing patterns in healthcare: trusted doctors with dangerous secrets, protected by the very systems meant to keep patients safe.

We’re talking about scandals so expensive, so brutal, so covered up—that it’ll leave you questioning who’s really watching over your care.

From gag orders to backdoor deals, and credentialing departments caught in the middle—we expose how silence gets bought, and the public pays the price.

🔪 Scalpel in one hand.
 💰 Millions in the other.
 🩸 And patients caught in the crossfire.

This one isn’t just wild—it’s a wake-up call.

Support the show

Resources Mentioned:

Verify your Nurses' Credentials:

https://www.nursys.com/

🔎 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 doctor is actually board certified?
Check for yourself right here:
👉 Verify a Plastic Surgeon

Because credentials do matter. 🩺✨

🌐 Connection Zone
Stay plugged in with your peers, share resources, and never miss an update....