Protecting Your Rights Against Sham Peer Review

Healthcare providers shaking hands with a Chapman Law Group healthcare defense attorney.

A suspension or revocation of medical staff privileges is one of the most harrowing experiences a physician can imagine. The damage from an adverse determination by a hospital’s formal hearing panel can be devastating. 

You can face the short-term effects of the inability to practice at the related facility, but also there is potential for related peer review actions by other credentialed entities including, reporting to the National Practitioner Data Bank (NPDB), reporting to and potential sanctions from medical board certification organizations, public and private insurance carriers, professional liability carriers and state boards of medicine.

Chapman Law Group’s Aaron Kemp discusses the National Practitioner Data Bank; reporting administrative actions; peer reviews and what federal immunity under the Healthcare Quality Improvement Act is about; summary suspensions; and other things licensing matters.

Do You Have the Right Information in Place?

The cornerstone of the defense of a physician under medical peer review will be to challenge the hospital’s conformance to the requirements of the Health Care Quality Improvement Act of 1986 (HCQIA) and the institution’s bylaws. It is imperative to begin to build an effective defense as soon as possible given the short timeframes for requesting a fair hearing, obtaining and reviewing relevant medical records and documentary evidence and obtaining expert witness support.

A checklist of critical information to compile as soon as possible in any potential physician peer review case includes the following:

      1. Your C.V.
      2. Any documents related to prior peer review or disciplinary matters
      3. Any communications, including emails and/or text messages, with hospital administration or fellow staff members
      4. A timeline of events leading to the incident(s) resulting in sham peer review
      5. A list of any prior criminal convictions, licensing sanctions or investigations and professional liability claims
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