Fair hearing and appeal process rights

The federal Health Care Quality Improvement Act of 1986 (HCQIA) was passed by Congress to extend immunity to good faith peer review of physicians and dentists and to create the National Practitioner Data Bank (NPDB). The statute is located at 42 United States Code section 11101 et seq.

Before HCQIA was enacted, a rise in malpractice actions from peer review cases resulted in physician reluctance to engage in peer review activities. In order to foster and promote peer review, HCQIA provided immunity from civil money damages to encourage physician involvement in such review actions. (See; 42 U.S.C. Section 11101 et seq. (1986) Healthcare Quality Improvement Act of 1986).

The question of fair hearing and appeal process rights for contracted physicians and allied health practitioners (i.e., nurse practitioners, physician assistants) is frequently raised. In this article, we review some of the issues related to fair hearing and appeal process rights under HCQIA that should be considered by hospitals and healthcare organizations when contemplating an extension of such a provision to those practitioners who may fall outside of the regulatory requirement. We also focus on when fair hearing and appeal process rights are required by regulation, the issue of waving such rights, and exceptions to immunity coverage that are not protected under the statute when providing such rights.

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