If the practitioner or other person requests a meeting with the QIO—
(a) The QIO panel that meets with the practitioner or other person must consist of a minimum of 3 physicians;
(b) No physician member of the QIO panel may be in direct economic competition with the practitioner or other person being considered for sanction;
(c) The QIO must ensure that no physician member of the QIO panel has a substantial bias for or against the practitioner or other person being considered for sanction;
(d) At least one member of the QIO panel meeting with the practitioner or other person should practice in a similar area, e.g., urban or rural, and at least one member of the panel must be in the same specialty (both requirements could be met by a single individual);
(e) If the practitioner or other person has an attorney present, that attorney will be permitted to make opening and closing remarks, ask clarifying questions and assist the practitioner or other person in presenting the testimony of expert witnesses who may appear on the practitioner's or other person behalf;
(f) The physician who recommends to the QIO that a practitioner or other person be sanctioned may not vote on that recommendation at the meeting;
(g) The QIO may allow the practitioner or other person 5 working days after the meeting to provide the QIO additional relevant information that may affect its finding; and
(h) A verbatim record must be made of the meeting and must be made available to the practitioner or other person promptly.
Notes of Decisions
Cited in
6
cases, 1987–1997 · leading case:
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
Lavapies v. Bowen, 687 F. Supp. 1193 (S.D. Ohio 1988).
· cites it 2× “42 C.F.R. § 1004.50 . Following review of the information provided by the practitioner in writing or at the meeting, the PRO makes a determination whether the practitioner has violated his or her obligation.”
Assar v. Crescent Counties Found. for Med. Care, 13 F.3d 215 (7th Cir. 1993).
· cites it 4× “The provider then has thirty days to submit additional information or to request a meeting to discuss the PRO’s determination ( 42 C.F.R. § 1004.50 ), 4 and the PRO may reconsider its decision in light of any additional information ( 42 C.”
Winter v. California Med. Review, Inc., 900 F.2d 1322 (9th Cir. 1989).
“” 42 C.F.R. § 1004.50 (c)(1). If the PRO recommends sanctions to the OIG, the practitioner may provide additional information to the OIG.”
Papendick v. Bowen, 658 F. Supp. 1425 (W.D. Wis. 1987).
“; 42 C.F.R. § 1004.50 . The notice must also provide that the practitioner has a right to submit additional information or a request for a meeting with the PRO within 30 days.”
Doyle v. Sec'y of Health & Human Servs., 848 F.2d 296 (1st Cir. 1988).
“After the Inspector General acts, the doctor is entitled to a full evidentiary hearing before an AU, and to appellate agency review.”
Corkill v. Shalala, 109 F.3d 1348 (9th Cir. 1997).
“See also 42 C.F.R. § 1004.50 (b)(6). The regulations do not require the attendance of the CMRI *1353 specialists who conducted the review of the sanctioned surgeon.”
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