Compliance, Credentialing & Risk Management Bureau

The Compliance, Credentialing & Risk Management Bureau reports directly to the Chief Deputy Commissioner and is responsible for credentialing of all licensed health care providers and certain other professional staff within Suffolk County’s Department of Health Services and the Medical Examiner’s office; maintaining Departmental compliance with the Health Insurance Portability and Accountability Act (HIPAA) and related privacy laws, through development of policies and procedures, staff training, and any other necessary steps to ensure compliance; performing risk management functions for the Department; and providing assistance and guidance to Department units regarding requests for release of information and other privacy-related issues.

Bureau activities include:

• Provider credentialing: The Bureau is responsible for initial credentialing and periodic recredentialling of all licensed health care providers and certain other professional staff within the Department of Health and the Medical Examiner’s office, in accordance with national guidelines. This includes primary source verification of education, residency and fellowship training, licensure, and board certification, as applicable, as well as required inquiries of former employers and other sources regarding privileges, malpractice, misconduct, fraud and abuse. In the case of an emergency or disaster, the Bureau will perform emergency credentialing if necessary for volunteer medical providers who are not on the NYS Health Department’s ServNY system.
• Compliance: The Bureau is responsible for maintaining the Department’s compliance with the Health Insurance Portability and Accountability Act (HIPAA) and related privacy laws, through development of policies and procedures, staff training, and any other necessary steps to ensure compliance. Bureau staff provide assistance and guidance to Department units regarding requests for release of information and other privacy-related issues and conduct investigations into any possible HIPAA breaches that are reported. Bureau staff also participate in the Department’s HIPAA Security Planning Group that works toward compliance with the HIPAA Security laws.
• Risk management: The Bureau performs risk management functions for the Department, including processing and maintaining all legal documents, engaging in incident review activities, assisting the County Attorney’s office in obtaining information needed to defend malpractice cases and loss control measures, and providing a report on the Department’s malpractice points allocation to County Risk Management. The Bureau also works with the Patient Care Services Division and the County Attorney to secure archived medical records for risk management purposes.
• Community Health Assessment & Community Health Improvement Plan. The Community Health Assessment (CHA) is a periodic evaluation of the community’s health priorities, prepared by Departmental staff using available statistics on the health status of the community, and information obtained through surveys and focus group interviews conducted by the Long Island Health Collaborative (LIHC). Findings from the CHA are used to develop the Community Health Improvement Plan (CHIP), which comprises a collection of strategic interventions designed to address the most pressing public health needs of County residents. CHIP projects involve evidence-based interventions, with specific, measurable and time-bound objectives, and often entail collaboration among multiple agencies.