42 U.S. Code § 11112 - Standards for professional review actions
Standards for professional review actions
(a) In generalFor purposes of the protection set forth in section 11111(a) of this title, a professional review action must be taken—
in the reasonable belief that the action was warranted by the facts known after such reasonable effort to obtain facts and after meeting the requirement of paragraph (3).
(b) Adequate notice and hearingA health care entity is deemed to have met the adequate notice and hearing requirement of subsection (a)(3) with respect to a physician if the following conditions are met (or are waived voluntarily by the physician):
(1) Notice of proposed actionThe physician has been given notice stating—
that a professional review action has been proposed to be taken against the physician,
that the physician has the right to request a hearing on the proposed action,
(2) Notice of hearingIf a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—
the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and
a list of the witnesses (if any) expected to testify at the hearing on behalf of the professional review body.
(3) Conduct of hearing and noticeIf a hearing is requested on a timely basis under paragraph (1)(B)—
(A) subject to subparagraph (B), the hearing shall be held (as determined by the health care entity)—
before an arbitrator mutually acceptable to the physician and the health care entity,
before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or
before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;
the right to the hearing may be forfeited if the physician fails, without good cause, to appear;
(C) in the hearing the physician involved has the right—
to have a record made of the proceedings, copies of which may be obtained by the physician upon payment of any reasonable charges associated with the preparation thereof,
to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and
(D) upon completion of the hearing, the physician involved has the right—
to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and
A professional review body’s failure to meet the conditions described in this subsection shall not, in itself, constitute failure to meet the standards of subsection (a)(3).
(c) Adequate procedures in investigations or health emergenciesFor purposes of section 11111(a) of this title, nothing in this section shall be construed as—
(1) requiring the procedures referred to in subsection (a)(3)—
where there is no adverse professional review action taken, or
precluding an immediate suspension or restriction of clinical privileges, subject to subsequent notice and hearing or other adequate procedures, where the failure to take such an action may result in an imminent danger to the health of any individual.
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