Peer Review & Credentialing

Over the past two decades, the laws governing peer review and physician credentialing have become increasingly burdensome. While state governments are responsible for regulating, licensing, and disciplining physicians, the federal government, through the Health Care Quality Improvement Act (HCQIA), mandates that hospitals are ultimately responsible for quality patient care, including care provided by its non-employee medical staff. The foundation of the law was to prevent physicians from moving state to state without disclosure of poor past performance. Now, undisclosed incompetence has become the burden of hospitals and the credentialing and privileging processes have become the means by which to reduce the risks of poor patient care by these physicians. Thus, obtaining full disclosure of physician past performance has become a necessity and a basis for privilege denial and termination.

At Baker Donelson, our attorneys have extensive experience in counseling hospitals, hospital management companies, political subdivisions and clinics in credentialing and privileging matters. We know that physicians struggle to keep their past performance issues out of data banks and use creative means to do so. Further, physicians fight privilege denial and termination actions by asserting a myriad of claims, including defamation, antitrust violations, discrimination, breach of contract, and unconstitutional due process. Baker Donelson provides a full spectrum of services to recognize and successfully resolve these issues.

Select Representative Matters

• Currently represent a regional hospital in which a cardiologist allegedly performed hundreds of unnecessary catheterization procedures. We represented the Hospital's Medical Executive Committee in the internal peer review process, which resulted in the immediate suspension of the physician’s privileges. We are currently assisting the Hospital with the grand jury investigation into potential violation of the False Claim Act.
• Represented a state university medical center in highly publicized and adversarial federal and state court companion lawsuits stemming from the termination of a tenured medical professor's staff privileges due to quality of care and improper consultation issues. We successfully obtained a summary dismissal of the claims which the physician appealed unsuccessfully to the U.S. Supreme Court.
• Represented a public hospital (a Quorum managed facility) in a matter concerning the suspension of hospital privileges of a cardiologist due to quality of care concerns. We represented the MEC during the internal peer review proceedings and in the subsequent litigation. The physician lodged every conceivable attack on the Hospital’s actions, including repeated requests for injunctive relief from the court. At each turn, those requests were denied and the lawsuit dismissed. The plaintiff physician sued the Hospital on a number of claims, but primarily alleged that the Hospital's peer review process was inherently unfair and denied her due process.
• Currently represent a hospital service district that suspended a surgeon's privileges. Following reinstatement of privileges after reprimand, the physician filed suit alleging discrimination claims. The matter is still pending in federal court.
• Represented an Oklahoma hospital in a matter where an ER physician had his privileges revoked due to alleged substance abuse.
• In a strict peer review action, represented a hospital service district that terminated a radiologist's privileges based on exclusive contracting.