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Medical peer review results available to beneficiaries who complain

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    NMU         WASHINGTON, D.C.         Freedom of Information    

Medical peer review results available to beneficiaries who complain

  • The results of a peer review of treatment must be disclosed to the complainant who seeks the review, an appeals panel in Washington, D.C. ruled, invalidating a government manual section calling for secrecy.

June 24, 2003 — Medicare and medicaid beneficiaries who complain to a medical peer review organization are entitled to see the results of their complaints, the U.S. Court of Appeals in Washington, D.C., ruled Friday. However the decision did not address whether they might pass that information on to others.

The decision gives David Shipp of Louisville, Ky., the right to see how a review board assessed the quality of the treatment three doctors at Baptist East Hospital gave his late wife Doris who died of cancer in 1999. The watchdog organization Public Citizen in Washington, D.C., sued on Shipp’s behalf.

The three-judge panel, affirming the decision of a lower court, ruled that the requirement for confidentiality in a government manual violates the law, in prohibiting disclosure to beneficiaries who have complained about medical practitioners and sought review of their work.

Under the Peer Review Improvement Act, private review groups assess complaints about medical treatment and medicare coverage. The act requires confidential treatment of information but it was amended in 1986 so that people who file complaints can learn the result of them.

The Department of Health and Human Services’ Health Care Finance Administration — now called the Centers for Medicare and Medicaid Services — did not change its rules and a manual allowed the complainant to learn only that a review had been conducted. The government argued in Shipp’s case that this was all the law required, but the courts disagreed.

The manual, followed by medicare and medicaid services, allowed a doctor who was assessed by a peer review organization to object to the release of its findings.

One doctor, for whom Shipp asked review, agreed to disclosure. But two did not, and Shipp was told that, without their consent, he could not learn the specific results of their reviews. That did not mean the reviews had identified any problems, but if they had, he could “be assured” that necessary action would be taken.

In the cases of all three doctors, Shipp was told that he could pass on no information about the review that disclosed identities without the doctors’ consent.

The law requires more disclosure than the government now permits, the appeals panel said, and it invalidated the sections of the manual that barred peer review organizations from providing that information to complaining beneficiaries.

(Public Citizen v. HHS; attorney: Amanda Frost, Washington, D.C.) RD

© 2003 The Reporters Committee for Freedom of the Press

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