Was Mount Sinai’s Victory in a Dispute Over a Physician’s Credentialing Worth It?

Dr. Nakul Karkare is an orthopedic surgeon in Long Island, New York, and has been an active staff member with full clinician privileges at South Nassau Communities Hospital in Oceanside since January 30, 2018, the day he went for his physician orientation at the hospital. That was roughly 11 months before Mount Sinai Health System formally acquired the regional hospital in December 2018. It was renamed Mount Sinai South Nassau thereafter.

He last performed surgery at that location on March 7, 2019, but that lack of activity in the years that followed hasn’t prevented the hospital from renewing his physician privileges in subsequent credentialing cycles. In July 2023, Dr. Karkare received the latest renewal of his privileges for a period of two years. Well after that period was over, the hospital extended his privileges until June 30 of this year.

Beyond that, however, it appears to be a no-go.

Physicians at Mount Sinai South Nassau as well as an administrative official from the parent organization have made it clear to Dr. Karkare that the hospital has new bylaws, and under these bylaws, the hospital can no longer accept his current qualifications, which include board certification from India and ACGME-accredited fellowships in the U.S. He would either need to resign or appeal the opinion of the Joint Credentials Committee of the hospital if it decided against him, they told him, adding that appealing the decision could have some dire consequences.

Dr. Karkare fought tooth and nail for several months, sending a barrage of emails, pointing out inconsistencies and charging that the hospital was running afoul of state and federal standards. But in an interview in April, he acknowledged that he wouldn’t file a renewal application with the hospital – this decision is not voluntary, he stressed. The hospital forced his hand.

Effectively, this would mean that Mount Sinai is getting what it wanted – Dr. Karkare will no longer have clinician privileges after June 30. However, if they were expecting him to go “gently into that good night,” they may have underestimated Dr. Karkare’s stomach to stir up trouble and fight what he believes is a gross injustice.

He has filed numerous complaints with state and federal agencies citing what he believes are violations of not only the hospital’s own medical staff bylaws but also CMS’ rules of participation and other rules pertaining to the Joint Commission. He has spoken to several news reporters. Agencies have acknowledged the complaints and are engaging with him. It remains to be seen if they conclude that Mount Sinai has not been compliant.

Mount Sinai South Nassau’s chief of surgery, the hospital’s chief medical officer, and its director of orthopedics did not respond to emails for comment. Neither did officials from the parent organization — specifically, the system vice president of medical affairs operations, and the vice president of medical affairs. After multiple emails were sent, a Mount Sinai spokeswoman responded to say that the health system doesn’t comment on individual personnel or employment matters. These include credentialing decisions that are considered “confidential.” The statement also read:

At Mount Sinai, all credentialing and recredentialing decisions are made through a comprehensive, objective review process that evaluates a range of factors, including clinical performance, adherence to professional standards, and alignment with institutional policies. These reviews are conducted by appropriate medical staff committees and leadership in accordance with established governance procedures.

This article is based on documents provided by Dr. Karkare.

What the Mount Sinai South Nassau Medical Staff Bylaws State
It appears that Mount Sinai South Nassau adopted new medical staff bylaws in June 2025, making certain changes with regard to board certification that were not in previous versions of the bylaws.

Section 15.3.2 of Part C, which focuses on “Credentialing and Privileging,” states the following:

For each of the specialties and subspecialties in which they intend to exercise privileges as set forth on the requested delineation of privileges, a Physician Applicant must be currently board-certified or, if not currently board-certified, must be currently board-admissible and then become board-certified within five (5) years of having completed formal training in that respective discipline, as defined by the appropriate specialty board of the American Board of Medical Specialties (ABMS), the American Osteopathic Association, the Royal College of Physicians and Surgeons in Canada and the United Kingdom, and the Australian Medical Council; or demonstrate equivalent professional competence as deemed acceptable by their Department Chair, the Joint Credentials Committee, and the Medical Board, and approved by the Board of Trustees. Any Physician Applicant boarded by another country’s certifying body (other than those listed above) must submit documentation to deem such certification as substantially equivalent to ABMS requirements.”

Dr. Karkare provided the previous bylaws that were approved on June 20, 2023, which did not contain this language. Indeed it appears the board certification was quite flexible. 

Board certification or board eligibility, as defined by requirements set forth by the specialty board in each practitioner’s field of medicine, surgery, and specialty or subspecialty thereof, will also be considered, unless such consideration is waived by the Medical Board. Those individuals not board certified at the time of the application to the Medical Staff shall be expected to proceed diligently to obtain board certification. It will be expected that those individuals will sit for their boards at the next eligible time that these boards are given. Failure to pursue board certification, according to these guidelines, will be taken into consideration when the applicant comes up for bi-annual reappointment.

A difficult Zoom call
On July 24, 2025, Dr. Karkare’s clinician privileges expired, and the expanded board certification requirements came into stark relief. He provided transcripts and audio recordings of a Zoom call between him and members of South Nassau’s physicians dating back to Nov. 10 last year, when he tried to get to the bottom of why getting a renewal of his clinician privileges was proving difficult. On that call, Dr. Rajiv Datta, Mount Sinai South Nassau’s chair of surgery, told him that his Indian board certification had become the sticking point.

“I think there’s an issue with the qualification,” Dr. Datta told Dr. Karkare. “Also, Nakul that they don’t accept the national board from India as equivalent to boards here. Actually, this is Mount Sinai. I’m not talking of South Nassau.”

Dr. Karkare responded that he has ACGME-accredited fellowships — Accreditation Council for Graduate Medical Education — to “show equivalent professional competence,” and the Mount Sinai bylaws state that “another country’s certifying body is also acceptable, but I need to submit the documentation for that.”

But another physician on the call — Dr. Stelios Koutsoumbelis, director of orthopedic surgery, Mount Sinai South Nassau — explained that the hospital’s Joint Credentials Committee cannot get past the foreign board qualification.

“So if the credentialing committee felt that the qualification was [equivalent], then that would be the end of this. But they don’t feel that the qualification is equivalent. So for that reason, there’s an opportunity for what’s known as a board waiver to have an alternative path of recredentialing,” Dr. Koutsoumbelis explained. “But that’s based off of a clinical need at the hospital where there’s like a niche that needs to be filled. Sort of like an emergency privilege would have to be granted. And after review, the committee doesn’t feel that the need is necessary. So they, they’re not willing to grant a board waiver.”

Since Dr. Karkare had not been active in the hospital recently, there was no way to push his case, Dr. Koutsoumbelis added.

After several back and forths on the issue of new bylaws, Dr. Karkare brought up his past history at the hospital.

“And my point is they have already accepted the qualifications many times over in the same hospital,” he said.

Indeed, even before the 2023 reappointment letter, he had been given full clinician privileges since he began practicing at the hospital in 2018. Later, after he stopped performing cases or assisting in them, his privileges were renewed. Finally, in December of 2025— six months after the new medical staff bylaws with changes to the board certification requirements were accepted — he received a notice that his privileges had been extended through June 30, 2026. According to the bylaws, physicians can receive privileges in two or three-year cycles. At least, for this extension, the hospital seems to have ignored his foreign board certification.

The new bylaws required documentation showing substantial equivalence if a physician held foreign board certification outside the countries specified in the bylaws. Dr. Karkare said he never submitted any additional documents, noting that the hospital and its board of trustees, who approved his credentials back in 2018, had already accepted his qualifications before and renewed them thereafter. He said he does not know whether the hospital reviewed his U.S. fellowships and qualifications since the new bylaws were adopted.

Dr. Karkare said he consulted with a New York lawyer late last year to get a legal opinion on his situation. That lawyer, after agreeing to an interview with this reporter canceled it. 

But another lawyer — though not in New York — said that if board qualifications are the only point of contention, federal law may be on Dr. Karkare’s side.

“I would be surprised if Mount Sinai is acting in a way that’s not consistent with their requirements under law or their bylaws, but I will say that if the only part in dispute is his board certification, under federal law, under the Medicare conditions of participation, it does say for the medical staff standard that the governing body must ensure that under no circumstances is the accordance of staff membership or privileges in the hospital dependent solely upon certification, fellowship, or a membership in a specialty body or society,” said Susan Kratz, an attorney with Nilan Johnson Lewis. 

The operative term is “solely.” 

Kratz noted:

“So when we look at 15.3.2 [section of Mount Sinai South Nassau’s June 20, 2025 bylaws], this is very specific to certification or membership in a specialty body or society. So under federal law, it says that a hospital can’t determine privileges dependent solely on certification. So if that is the only thing that is driving the dispute and the hospital’s decision that he’s not eligible for reappointment, … I don’t know how they see that that is compliant with federal law.”

On the call with Dr. Karkare in November, Dr. Datta, Mount Sinai South Nassau’s chair of surgery, repeated four times that the hospital’s Joint Credentials Committee is not “accepting your qualification” and stated nine times that everyone is “stuck” on that point.

They told him twice he had the option to resign or the option to appeal, but declared that there are consequences to the latter.

“We don’t like being the, you know, the messengers here either, but … our hands are tied to the system level,” said Dr. Koutsoumbelis, director of orthopedic surgery, Mount Sinai South Nassau. “So you have the right to appeal. If you appeal, you go in front of the board to discuss this with them or they review your case, et cetera. But if they say no to the appeal, then what happens is … it’s considered like a non-renewal on the privileges. And a non-renewal is not good because that gets reported in the database.”

The database that Dr. Koutsoumbelis is referring to is the National Practitioner Data Bank (NPDB), which is an online database of reports containing information on “medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers,” according to its website. Congress established the database in 1986, and it is meant to be “a workforce tool that prevents practitioners from moving state to state without disclosure or discovery of previous damaging performance.” 

If Dr. Koutsoumbelis’s comment about the non-renewal of privileges being reported to the NPDB was meant as friendly advice, Dr. Karkare did not take it as such. He interpreted it as a direct threat.

“Reporting to the national data bank is like a death sentence really, which means that anytime you apply to any other hospital it comes up,” he said in an interview.

But Dr. Koutsoumbelis’s threat/advice appears to be incorrect. 

Kratz, the Minneapolis healthcare attorney, read aloud from the NPDB website: “Administrative actions that do not involve a professional review action should not be reported to the NPDB. For example: A hospital’s bylaws require physicians to be board certified in their specialty. A physician’s board certification expires and, as a result, the hospital automatically revokes the physician’s clinical privileges through an administrative action. The revocation of clinical privileges was not a result of a professional review action and should not be reported to the NPDB.”

Lack of activity at Mount Sinai South Nassau
A second call Dr. Karkare recorded occurred on Jan. 5 of this year.

Before this second call, oddly enough, he received an email from South Nassau saying that as of December 30, his appointment at the hospital had been extended from July 24, 2025, when it expired, to June 30 of this year. This despite the fact that he was being told that Mount Sinai wasn’t accepting his qualifications.

Interestingly, with the extension to June 30, the category of Dr. Karkare’s medical staff membership appears to have been downgraded to “associate staff” with full admitting and discharging privileges, from “active staff.”

On the second call, Dr. Datta and Dr. Koutsoumbelis were joined by Dr. Alan Wong, chief medical officer and senior vice president for medical affairs at Mount Sinai South Nassau, and Anne Roberts, system vice president of medical affairs operations at Mount Sinai Health System.

Dr. Wong stressed that the hospital has voted to accept Mount Sinai’s bylaws, and adhering to them is required. He also attempted to get an understanding of who else, besides Dr. Karkare, from his practice was either seeking to get a reappointment letter or credentialed for the first time.

“We need to make sure that if you are requesting privileges, that your team, including everyone who’s active in the team, has the volume to show competency,” Dr. Wong said.

And the reality is that despite having privileges at South Nassau, Dr. Karkare has not been active at the hospital. The last time that Dr. Karkare practiced at that location was several years ago — it was actually on March 7, 2019. Dr. Wong asked him where he currently practices, and Dr. Karkare told him that he does elective cases at Lenox Hill Hospital in New York City, which is part of Northwell Health, and St. Catherine of Siena Medical Center in Long Island. His team members practice at Mather Hospital, Southside Hospital (now known as South Shore University Hospital), Peconic Bay Medical Center and St. Catherine, he said. 

But he explained that he and his team would like to become active in South Nassau once again and so even newer members of the team who have board certification from the U.S. would like to receive privileges at South Nassau.  

Nowhere on that call in January do they discuss that as of December 30, 2025, the category of his membership is now at the “associate staff” level, which occurs when a physician has not met the eligibility requirements for being an “active staff” member at the hospital. One of those requirements is volume of activity — specifically, the physician needs to “Engage in at least twelve (12) Hospital encounters per year,” according to the bylaws. Per the bylaws, hospital encounters can mean several things but the term is not exclusive to performing procedures.

On that call, Anne Roberts, Mount Sinai’s system vice president of medical affairs operations, explained that as the parent system’s 2021 bylaws are being adopted throughout various hospitals across Mount Sinai, 80-85 other physicians have, like Dr. Karkare, fallen outside of the requirements for medical staff membership. As a result, their privileges weren’t renewed. 

She told Dr. Karkare that the system had inadvertently sent him a reappointment application in mid December, requesting him to renew his privileges, and apologized for it, given that his privileges were extended till June 30. 

They decided that all members of his staff seeking privileges at South Nassau should update or submit new applications. The call ended with Dr. Wong trying to bring the temperature down through collegiality.

“What I’ll say is, from the medical leadership team, we’re not here to cause trouble for our physician members as well,” he said. “That was never an intent to do so.”

He noted that Dr. Karkare is bringing up issues that he doesn’t fully understand, but said that he would let the “expert team evaluate.”

No one on this call asked him to resign.

There are Inconsistencies and Violations, Karkare Alleges
If one reviews Dr. Karkare’s reappointment letter from Mount Sinai dated July 28, 2023 pasted below, some inconsistencies are immediately clear. It shows the current appointment cycle date beginning on July 27, 2023, and beneath that, a date range: 04/18/2011 to 07/24/2025.

And then, inexplicably, one line below is this date: 01/01/2099. Dr. Karkare will have to avail himself of some divine elixir to live until the end of this century.

But he charges even the start date is inaccurate — he wasn’t even in New York on April 18, 2011, as the reappointment letter states. A CV he provided shows that he was doing a one-year trauma fellowship in York Hospital in Pennsylvania between June 2010 and June 2011. And according to Dr. Karkare’s own records, his first day at the hospital was Jan. 30, 2018.

According to the 2023 reappointment letter, his privileges expired on July 24, 2025, but it was not until December 30 of last year that he received an extension until June 30. As mentioned above, on the Jan 5 call, Roberts apologized for the fact that he had received the application to renew when the system had already decided to extend his privileges at South Nassau. That renewal application requested him to complete it within two weeks. In fact, even after Robert’s apology in January, a second reappointment application was sent to him on Feb. 2, again with a two-week deadline to submit. 

That appears to contradict Mount Sinai’s own bylaws which state that: Failure, without good cause, to provide all subsequently requested information at least three (3) months prior to the expiration of their current Membership and/or Clinical Privileges, may result in cessation of processing of the Reapplication and automatic expiration of their Membership and/or Clinical Privileges when the current Appointment/Privileging period concludes.”

Since June 30, 2026 is the date when his privileges expire, then Dr. Karkare would have had at least until March 30 to complete his renewal application. 

Meanwhile, on the Jan. 5 call with Roberts and others, Dr. Karkare explained that the hospital’s stance that his board qualifications are not acceptable appears to be in contradiction to New York State laws, CMS rules of participation and Joint Commission laws. He also told them that the revocation of privileges of 80-85 physicians due to the adaptation of Mount Sinai’s medical staff bylaws may be a violation of the law and offered to help the system correct the problem.

Roberts disagreed vehemently, stating the hospital is not in violation of any laws, but she clearly rubbed Dr. Karkare the wrong way. After the call ended, Dr. Karkare did some background research to unearth the fact that Roberts is not admitted to practice law in New York. In his mind, she was dispensing legal advice to Mount Sinai Health System without a license.

It’s not clear whether being on calls to discuss legal or disputed matters on credentialing and signing off her email as J.D. and Esq., as Roberts did, violates New York law, as Dr. Karkare alleges. But Karkare said he lodged an official complaint with the state in March.

Before doing that, he informed Dr. Koutsoumbelis and others that Roberts does not hold a law license in New York. Dr. Koutsoumbelis appeared to acknowledge the lapse and on Jan. 15, sent an email to Dr. Karkare that stated in part: “I also want to note that, following the recent meeting, Ms. Roberts recused herself from further involvement in this matter, and oversight has transitioned accordingly.” 

It’s not clear whether Roberts actually recused herself. An email inadvertently sent to Dr. Karkare on Feb. 18 shows that she was copied on an email discussing his case. 

Neither Roberts nor Dr. Koutsoumbelis returned emails seeking comment.

Dr. Karkare added that physicians from Karkare’s practice, including those with American board certification, submitted applications to be admitted to South Nassau as medical staff. Those applications were never processed.

His emails complaining of wrong reappointment criteria being used for his renewal application were forwarded to Dr. Brijen Shah, vice president of medical affairs at Mount Sinai Health System, who responded to him on Feb. 2. Dr. Shah stated that the hospital is not in violation of any laws and urged Dr. Karkare to complete his reappointment application within two weeks. That, again, appears to run counter to Mount Sinai South Nassau’s own bylaws, which, as mentioned above, allow physicians a final submission deadline of 3 months before the expiration of privileges, which is June 30 for Dr. Karkare. 

In fact, so incensed was Dr. Karkare after the calls and emails, that he began to contact various state and federal agencies to file official complaints. There are too many complaints to formally track, but he says that they are not resolved.  Here are two acknowledgments he has received, from the New York Department of Health and from the Joint Commission.

Why did Mount Sinai want to push out Dr. Karkare?
Karkare hasn’t been active at the hospital in terms of performing surgery over the past few years. So from a business perspective, having an NPC (“non-playing character” in video game parlance)  perhaps did not benefit the hospital. But Kratz, the attorney, said the lack of activity is more than just a business decision.

“Well, it’s actually more of a patient care question. If you’re not seeing patients in our hospital, we can’t assess whether you can practice at the level of quality that we need to hold our physicians accountable to. So it’s not a business decision, it’s not an economic decision, it’s a quality decision.”

Kratz said inactivity in combination with the fact that suddenly his board qualifications are in question could be a reason for not wanting to renew his clinician privileges. Karkare counters that under the Bylaws Section 17.3.3, limited clinical activity is addressed by curtailing privileges to match actual activity — not by termination of membership or denial of reappointment.

That section also states: Relinquishing Clinical Privileges under this circumstance is not considered a result of corrective or disciplinary action and does not require reporting to licensing and regulatory agencies.

However, the minimum 12 encounters (which are not limited to only performance of a procedure) that a physician must meet in terms of activity at the hospital according to the bylaws were never clearly mentioned to Dr. Karkare. Especially in the first call with Dr. Datta and Dr. Koutsoumbelis, while lack of Dr. Karkare’s clinical activity in the past two preceding years was noted, the sticking point appears to be his Indian board certification.

Yet, he has been inactive at the hospital since the end of March 2019, and received renewal of his privileges even in 2023 and earlier. His level of activity didn’t change. Nor did his board certification.

Could it have been simpler for Mount Sinai to just renew his application at the “associate staff” level and not the “active staff” level, instead of making him think he had no option but to resign because or potentially be reported in the NPDB database? If they had, they would have been spared Dr. Karkare’s incessant, lengthy emails alleging a litany of violations and now potential investigations.

Without comment from any Mount Sinai official, it’s hard to guess at motives.

Not surprisingly, Dr. Karkare sees darker motives at play.

“Independent physicians try to negotiate their terms, compete for patients. Employed physicians really have no control, no due process, and no recourse. Hospitals make money from employed physicians and the downstream revenue from ancillary income,” he wrote in an email. “Removing independent physicians and replacing them with employees who are fully dependent on the institution is not a quality decision. It’s about money and control. The system is built to make fighting back cost more than surrendering. The NPDB report is permanent. Due process hearings in the hospital is a sham. Eighty-five physicians disappeared quietly since 2021. Most never knew the others existed. The institution counted on that isolation. Each physician who chose resignation knew — don’t push back.”

Meanwhile, he said he continues to perform surgery at various area hospitals that are not owned by Mount Sinai.

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