Credentialing and Peer Review

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The COVID pandemic has illuminated the need to modernize professional licensing.  Although professional licensing has always been a necessary vigilance with licensing has always been appropriate, and never more so than as highlighted by the opioid epidemic and telemedicine fraud schemes when physicians could issue prescriptions and orders for services over the internet for patients…

Ever more frequently, hospitals require physicians to indemnify them as part of the credentialing process. Although the HCQIA may allow for recovery of attorneys fees arising from frivolous litigation, that is different from complete indemnification.  Furthermore, in Pennsylvania, hospital licensing requirements limit hospitals’ rights in this area.  I have attached a copy of the article…

The Pennsylvania Superior Court has decided the Pennsylvania Peer Review Protection Act does not apply to alleged peer review activity conducted by Blue Cross of Northeastern Pennsylvania, because Blue Cross is not a professional healthcare provider as defined in the Pennsylvania Peer Review Act.  Blue Cross argued it should have been protected because it’s activities…

All states have some degree of confidentiality protection for peer review activities and the information generated by those activities, and there is additional federal protection for information gathered and created by Patient Safety Organizations (PSOs), established pursuant to the Patient Safety and Quality Improvement Act (PSQIA) of 2005.

However, physicians, hospitals, and medical staffs should…

42 U.S.C. § 1981 prohibits discrimination affecting citizens rights to make contracts. In the credentialing field, § 1981 has been used to circumvent the immunities provided by the Health Care Quality Improvement Act (HCQIA) because HCQIA provides an express exception stating that it doesn’t apply to actions brought pursuant to Section 1981.

The premise is…

In Kates v. Doylestown Hospital, the Pennsylvania Superior Court, in a non-precedential decision, held back the Pennsylvania Peer Review Protection Act does not provide confidentiality protection for certain records, stating:

Peer review necessarily involves evaluating the quality of care provided by medical professionals or evaluating the qualifications of medical care providers. 0045cept for those

…

The American Health Lawyers Association Regulatory Accreditation and Payment Practice Group (RAPPG) has issued an email alert regarding the issuance of a final rule by CMS intending to streamline Medicare regulatory requirements.  Two aspects of that rule which are a great concern to physicians are:

  • Allowing hospital systems with more than one hospital to use

…

In Copeland v. MidMichigan Regional Medical Center, a Michigan State Appellate Court affirmed a trial court’s grant of summary judgment in favor of the Hospital, based upon both HCQIA immunity and a general release signed by the physician as part of the initial medical staff application process. 

These releases are almost universally included in …

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