The government must disclose to Medicare patients the results of its investigations into complaints about the quality of their care, a federal appeals court ruled Friday.
Even if it means providing information that specifically identifies the physician, peer-review organizations contracted by HHS to review Medicare beneficiaries' complaints must notify the patient of the results of the review, said the decision by the U.S. Court of Appeals in the District of Columbia in an affirmation of the July 2001 ruling of a district court.
The practice of HHS has been not to reveal the details of the findings of PROs, now called quality improvement organizations, when doctors do not consent to the release of information. The organization instead sends a form letter that states only that the agency will take action if warranted.
The three-judge panel on Friday said such a letter, even when based on an HHS manual, does not meet the requirements of the Peer Review Improvement Act of 1982 as amended in 1986.
"We conclude that, to 'inform' a Medicare beneficiary of the organization's 'final disposition' of the complaint as required by (statute), a PRO must disclose its determination as to whether the quality of the services that the recipient received met 'professionally recognized standards of health care,'" said Circuit Court Judge Merrick Garland, who wrote the opinion.
Public Citizen brought the case against HHS in 2000 on behalf of David Shipp, whose wife, Doris Shipp, died of cancer in June 1999. Her husband filed a complaint about the care she received from three doctors at Baptist East Hospital in Louisville, Ky., in 1998 and 1999.
The peer-review organization did not tell Shipp the results of the investigation of two of the doctors because the physicians did not give their consent.
The government argued that maintaining provider confidentiality met the requirements of the law and the intent of Congress, but the court disagreed.
"It is hardly surprising that Congress would permit disclosure to the party with the most direct interest in the information--the person who received the medical services at issue and whose complaint initiated the investigation--while barring disclosure to others, or even to the same recipient in a litigation context," Garland wrote.