Questions You Should Ask and Know Answers
|1. Question: When considering legal action in response to adverse action of a hospital credentialing body or a state medical board, what are the pluses and minuses of filing suit in STATE versus FEDERAL court? Or should you file in both?
2. Question: How soon in a credentialing or administrative process do you break and run to court? Do you HAVE TO wait until the entire process unravels, or is there a point you can go to court before that (e.g. for injunctive relief, etc)?
3. Question: Do we know for certain, nationwide, that your own peer review and credentialing materials are discoverable BY YOU?
4. Question: When we sue the board of medicine or the hospital committees, do we sue in their individual capacities, too? Or just official?
5. Question: Anyone ever file a writ of mandamus to make the medical board do the job it is assigned by law to do? In other words, rather than rubber stamp the findings of its investigator or the complaints before it, can't you MAKE THE BOARD do the proper investigations as required by statute? Or is there no case law to support that idea?
6. Question: Is anyone aware of any medical societies/associations that do peer review that is covered under the Health Care Quality Improvement Act?
8. Question: Who pays for peer review? Who pays to assure it is impartial?
9. Question: How can one overcome the alleged immunity of the peer review perpetrators?
9. Answer: Immunity may be challenged if the entity is not a "health care entity" as defined in HCQIA; if there was no adequate investigation prior to taking the action; if there is evidence that the action was not taken in good faith for the improvement of quality health care (antitrust or similar intent); or if there is evidence that the action was taken for malicious motives. "Malice" has been held to include the reckless disregard for the falsity of the accusations- another good avenue is if there is evidence that witnesses deliberately lied when they testified against the physician. If all the evidence is contained in the transcript of the peer review hearing, there is a huge hurdle to getting admissible proof that gets you past summary judgment for the hospital. Chris Sharp JD, email@example.com
10. Question: How much of the peer review proceedings may be revealed in private or made public? Does the alleged privilege refer to proceedings or only to identifying patient information?
11. Question: Has any one been successful for defamation on the basis of the NPDB report?
13. Question: If a health plan denies credentialing for a provider based on action taken by a hospital, licensing board, Medicare, or some other "reporting" body, is the health plan also required to report to the data bank, or can the health plan rely on the fact that the other body, e.g., state licensing board, has a duty to report the provider?
14. Question: If a health plan denies an initial application for credentialing based on past malpractice claims or action by a licensing body, is that initial denial reportable, or are only re-credentialing denials reportable?
15. Question: Has anyone come across helpful resources related to reporting requirements for health plans?
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