U.S. Code » Title 42 » Chapter CHAPTER 117— ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES › Subchapter SUBCHAPTER I— PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES

42 U.S.C. § 11112

Standards for professional review actions

Read at: OLRCuscode.house.gov CornellLII GovInfogovinfo.gov JustiaTitle 42 CasesGoogle Scholar
(a) In generalFor purposes of the protection set forth in section 11111(a) of this title, a professional review action must be taken—(1) in the reasonable belief that the action was in the furtherance of quality health care,(2) after a reasonable effort to obtain the facts of the matter,(3) after adequate notice and hearing procedures are afforded to the physician involved or after such other procedures as are fair to the physician under the circumstances, and(4) 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).A professional review action shall be presumed to have met the preceding standards necessary for the protection set out in section 11111(a) of this title unless the presumption is rebutted by a preponderance of the evidence.(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—(A)(i) that a professional review action has been proposed to be taken against the physician,(ii) reasons for the proposed action,(B)(i) that the physician has the right to request a hearing on the proposed action,(ii) any time limit (of not less than 30 days) within which to request such a hearing, and(C) a summary of the rights in the hearing under paragraph (3).(2) Notice of hearingIf a hearing is requested on a timely basis under paragraph (1)(B), the physician involved must be given notice stating—(A) the place, time, and date, of the hearing, which date shall not be less than 30 days after the date of the notice, and(B) 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)—(i) before an arbitrator mutually acceptable to the physician and the health care entity,(ii) before a hearing officer who is appointed by the entity and who is not in direct economic competition with the physician involved, or(iii) before a panel of individuals who are appointed by the entity and are not in direct economic competition with the physician involved;(B) 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—(i) to representation by an attorney or other person of the physician’s choice,(ii) 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,(iii) to call, examine, and cross-examine witnesses,(iv) to present evidence determined to be relevant by the hearing officer, regardless of its admissibility in a court of law, and(v) to submit a written statement at the close of the hearing; and(D) upon completion of the hearing, the physician involved has the right—(i) to receive the written recommendation of the arbitrator, officer, or panel, including a statement of the basis for the recommendations, and(ii) to receive a written decision of the health care entity, including a statement of the basis for the decision.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)—(A) where there is no adverse professional review action taken, or(B) in the case of a suspension or restriction of clinical privileges, for a period of not longer than 14 days, during which an investigation is being conducted to determine the need for a professional review action; or(2) 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.(Pub. L. 99–660, title IV, § 412, Nov. 14, 1986, 100 Stat. 3785.)
Notes of Decisions
Cited in 254 cases (16 in the last 5 years), 1990–2026 · leading case: Harris v. Bradley Mem'l Hosp. & Health Ctr., Inc., 994 A.2d 153 (Conn. 2010).
Sort: Relevance Newest Treatment
Harris v. Bradley Mem'l Hosp. & Health Ctr., Inc., 994 A.2d 153 (Conn. 2010). · cites it 14× “In its second motion for summary judgment, the defendant argued that it was immune from liability for damages with respect to proceedings prior to and including the February 13, 2001 summary suspension of the plaintiffs clinical privileges on the basis of the emergency provision…”
Alan D. Gordon, M.D. Alan D. Gordon, M.D., P.C., a Corp. Mifflin Cnty. Cmty. Surgical Ctr., a Corp. v. Lewistown Hosp., 423 F.3d 184 (3rd Cir. 2005). · cites it 8× “He also argued alternatively that even if there was a professional review action, the requirements for obtaining HCQIA immunity set forth in 42 U.S.C. § 11112 (a) were not met. The District Court determined that application of the solicitation exception turned on the subjective…”
Singh v. Blue Cross/Blue Shield of Massachusetts, Inc., 308 F.3d 25 (1st Cir. 2002). · cites it 9× “42 U.S.C. § 11112 (a). The HCQIA standards “will be satisfied if the reviewers, with the information available to them at the time of the professional review action, would reasonably have concluded that their action would restrict incompetent behavior or would protect patients.”
Stephen P. Sugarbaker, m.d.,appellant/cross-appellee v. Ssm Health Care, D/B/A St. Marys Health Ctr.,cross-Appellant/appellee, 190 F.3d 905 (8th Cir. 1999). · cites it 11× “42 U.S.C. § 11112 (a). See also Wayne v. Genesis Med.”
Granger v. Christus Health Cent. Louisiana, 144 So. 3d 736 (La. 2013). · cites it 9× “See 42 U.S.C.A. § 11112 (a). HCQIA notice and hearing procedures, required by 42 U.”
Wahi v. Charleston Area Med. Ctr., Inc., 562 F.3d 599 (4th Cir. 2009). · cites it 3× “In so doing, it analyzed each of the four components that a professional review action must possess in order to qualify for immunity, as set forth in 42 U.S.C. § 11112 (a), and concluded that CAMC fulfilled each requirement.”
MacArthur v. San Juan Cnty., 416 F. Supp. 2d 1098 (D. Utah 2005). · cites it 10× “§ 248 )-1137 (3) Health Care Quality Improvement Act, 42 U.S.C. § 11112 (2000).1138 (4) Emergency Medical Treatment and Active Labor Act (EMTALA), 42 U.”
Talwar v. Mercer Cnty. Jt. Twp. Cmty. Hosp., 520 F. Supp. 2d 894 (N.D. Ohio 2007). · cites it 35× “of a professional review body” satisfies the requirements under 42 U.S.C. § 11112 (a), then “(A) the professional review body, (B) any person acting as a member or staff to the body, (C) any person under a contract or other formal agreement with the body, and (D) any person who…”
Reyes v. Wilson Mem'l Hosp., 102 F. Supp. 2d 798 (S.D. Ohio 1998). · cites it 15× “” 42 U.S.C. § 11112 (a)(1). Second, it must be taken after “a reasonable effort to obtain the facts of the matter.”
Patrick v. Floyd Med. Ctr., 565 S.E.2d 491 (Ga. Ct. App. 2002). · cites it 12× “Patrick contends that the superior court erred in granting the Hospital summary judgment in that jury questions exist as to the Hospital’s entitlement to immunity in the peer review process under 42 USC § 11112 (a) (1) through (4) of the Act and OCGA §§ 31-7-132 and 31-7-141.”
Bakare v. Pinnacle Health Hospitals, Inc., 469 F. Supp. 2d 272 (M.D. Penn. 2006). · cites it 13× “The QA Committee’s concerns were then corroborated by an independent OB/GYN expert who concluded that “beyond a reasonable degree of medical certainty [Dr.”
Egan v. Athol Mem'l Hosp., 971 F. Supp. 37 (D. Mass. 1997). · cites it 12× “42 U.S.C. § 11112 (a). These requirements, as they relate to the case at hand, are discussed below.”
Show all 254 citing cases →
— 42 U.S.C. § 11112(a) — 5 cases
Chalal v. Nw. Med. Ctr., Inc., 147 F. Supp. 2d 1160 (N.D. Ala. 2000).
Burney v. East Alabama Med. Ctr., 939 F. Supp. 1514 (M.D. Ala. 1996).
Brandner v. Providence Health & Servs. - Washington, 384 P.3d 773 (Alaska 2016).
Sherr v. HealthEast Care Sys. (D. Minnesota 2019).
Emory Healthcare, Inc. v. Jason H. Harms (Ga. Ct. App. 2026).
— 42 U.S.C. § 11112(a)(2) — 1 case
Joseph C. Curtsinger, Jr. M.D. v. HCA, Inc. (Tenn. Ct. App. 2007).
— 42 U.S.C. § 11112(a)(3) — 1 case
Emory Healthcare, Inc. v. Jason H. Harms (Ga. Ct. App. 2026).
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.