- June 3, 2025
- Credentialing
At Modio, the need for an overhaul of the provider credentialing process is a priority. Credentialing is foundational to healthcare safety, designed to verify that clinicians are who they say they are and qualified to treat patients. It’s also a complex, often cumbersome process. While companies like Modio are leveraging technology to make credentialing more efficient and secure, the system itself is long overdue for a full-scale transformation.
This urgency is underscored by a recent article in the San Francisco Standard reporting on a disturbing trend: chatbots impersonating licensed mental health providers and fooling patients into thinking they were speaking with real professionals. According to the article, “The chatbots provide random license numbers and claim to be certified by state boards and hold degrees from top universities.” What this incident reveals is not just a failure of technology, but also a gap in regulatory infrastructure. Without a standardized, enforceable system for credential verification, the door is left open to exploitation from both bots and bad actors.
A key takeaway is that the stakes for provider credentialing have never been higher.
AI is undoubtedly advancing healthcare, but it’s also making it easier to forge credentials and mimic trusted authorities. It’s important that our sector step up, not just to keep pace with innovation, but to stay ahead of the risks it introduces. That means rethinking how healthcare provider qualifications are authenticated.
Strengthening the workflows that verify when patients are engaging with real, credentialed providers, not just AI chatbots posing as clinicians, is a strong start. Just as the banking industry relies on KYC (“Know Your Customer”) standards to guard against fraud and financial crime, the healthcare sector needs a parallel framework to verify and protect the integrity of provider identities. This includes ensuring that every provider claiming to offer care has undergone primary source credential verification and that an actual human remains a core part of the process. Establishing these guardrails is critical not only for patient safety, but also for preserving trust as innovation continues to move forward in healthcare.
As technology continues to reshape the landscape, different approaches to credentialing are needed — ones that balance the power of automation with the judgment and oversight that only human beings can provide. AI can help make the process smarter. But the sector still needs people to ensure it stays safe.
Learn more about Modio Health and how we simplify provider credentialing.