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"Doctor" Dennis Edward Roark practiced medicine for more than a decade, never running afoul of the credentialing process at the many institutions where he worked — despite the fact that he was not a doctor. But then he applied for privileges at Ingham Regional Medical Center in Lansing, MI. That’s where he found out that a good credentialing program can be quite a hurdle for a fake doctor.
Roark, 39, a resident of Sterling Heights, MI, pleaded guilty July 15 in Ingham County Circuit Court to a felony charge of using false documents to obtain a medical license. He faces up to 14 years in prison. He also faces possible federal charges for Medicare and Medicaid fraud, related to claims he filed while pretending to be a doctor, plus state charges of insurance fraud.
Roark claimed on state licensing applications and his curriculum vitae that he was a 1986 graduate of Rush University Medical School in Chicago, but the school says he never attended. Prosecutors also say Roark used forged documents, including medical board test scores, to gain admission to four residency programs in Michigan, Ohio, and a Canadian province. Hospitals where he worked report that Roark participated in more than 300 operations, including heart transplants and amputations, though his exact involvement in those procedures remains unclear, prosecutors say.
In addition to the criminal penalties he faces, a disciplinary subcommittee of the Michigan Board of Medicine has fined Roark $100,000 for using phony documents to obtain a medical license. Roark has told the court he has no funds to pay the fine, but failing to pay within 30 days could mean additional prison time. The Detroit Free Press reports that at least two lawsuits have been filed against Roark by former patients, and state officials are investigating cases in which Roark’s care may have led to injuries or the death of patients.
His medical license was suspended April 2, when the apparent deception was discovered, but by then, Roark had posed as a heart and lung surgeon for four years and held other physician positions for another 16 years. He had worked in the urgent care center at Madison Heights Community Hospital from 1994 until early 1998. He also participated in a one-year training program at St. Joseph Mercy-Oakland Hospital in Pontiac, MI.
At Madison Heights Community Hospital, chief operating officer Tim Dengel says the facility acted appropriately in credentialing Roark. The state verified that Roark had a valid medical license, he says, and there was no reason to suspect that any of Roark’s credentials were invalid.
It is difficult to determine exactly what Roark’s experience was, even though it is now known that he posed as a physician for many years and undoubtedly performed many medical procedures and prescribed drugs. While Roark claimed in a summary of cases to the American Board of Thoracic Surgery that he had participated in more than 500 procedures, including eight heart transplants and four lung transplants, prosecutors now say that may have been another lie told to bolster his credentials.
It appears that Roark never encountered any serious threats to his charade until he applied for privileges at Ingham Regional Medical Center. He never got as far as practicing there, and risk manager Michelle Hoppes, RN, AHRMQR, says no one at the facility had even heard of him when he submitted his application. There was no immediate cause for concern, she says. Roark was just one more doctor applying for privileges, so they put his application through the same verification process that all others go through.
Then a few phone calls started setting off the alarm bells and set into motion the process that ultimately would send Roark to prison.
"From a risk management standpoint, this was a very proud day," Hoppes says. "It really shows that risk management is not just the risk manager’s job. I’m so proud of our staff and that we were able to stop an individual who could have posed a significant liability risk for our organization and threatened our patients."
Linda Nash, MD, medical director at the hospital, was in charge of overseeing the credentialing of physicians, and it was her investigation that blew Roark’s cover. How did she do it? "I can tell you in two words: Primary verification," she says. "You can’t take anyone else’s word that the credentials are valid. You have to go right to the source and verify it yourself."
The hospital has a strict policy of requiring primary verification for physician credentialing, Hoppes says. Obviously, not all facilities have the same requirement, relying instead on simply seeing that the applicant has an apparently valid state license and possibly checking his most recent employment. Hoppes and Nash say that’s not enough because you’re relying on others to verify that the applicant’s string of credentials is valid. As Roark demonstrated, even having a "valid" license to practice medicine from the state is not sufficient proof the applicant has all the training and experience he or she claimed to get the license.
Even if the application is valid with regard to the most important and basic items, such as graduation from a medical school, there may be outright lies or excessive exaggeration about other points that are crucial for whatever type of care the physician intends to provide at your facility.
Hoppes points out that many regulatory bodies require health care providers to verify the credentials of applying physicians, but they usually do not specify exactly what "verification" must entail. Many facilities take a somewhat lax approach, she says, but her hospital always has believed that "verification" means "primary verification" of all significant training and credentials. The risk management department conducts annual audits of the credentialing process, reviewing the files to ensure primary verification.
"We work closely with the credentialing process to make sure that any time there is a red flag, we hold up the whole process and put the burden on the physician to give us what we need," Hoppes says. "Sometimes there is pressure to move things along, but we will not rush the process. A lot of organizations depend on other facilities and the state to have done all the proper credentialing, but it’s quite clear to us that we have to depend on ourselves."