This is a series describing the ten important pro-immunity peer review cases where court have granted immunity to peer reviewers under the Health Care Quality Improvement Act of 1986, 42 U.S.C. Sec. 11112 (“HCQIA”).
No. 2: Singh v. Blue Cross and Blue Shield, Inc. of Massachusetts, 308 F. 3d 25 ( 1st Cir., 2002)
Dr. Singh, an internist, filed suit against the Blues of Massachusetts and an independent consultant over a recommendation for his exclusion from insurance plans based on concerns over the allegedly excessive use of pain medication for chronic problems and usually lengthy regimens of antibiotics for his patients. He sued for breach of contract, tortious interference with business relationships with patients, defamation and violation of state consumer protection statutes. After a “fair hearing” his exclusion was reversed and he was reinstated as a provider in the insurer’s system.
The trial court and the Court of Appeals agreed that his action should be dismissed both on their merits and on the HCQIA immunity defense.
The reversal of a peer review committee’s recommendation by a higher level peer review panel does not indicate that the initial recommendation was made without a reasonable belief that the recommendation would further quality health care.
The court looked to the attention to detail paid by the defendants to the health care issues as a basis for its determination that the “reasonable belief” standard was a bar to aw damages claim.
Given the two audits and the level of attentions Dr. White gave to each chart he reviewed, no reasonable jury could find that Dr. Singh overcame the statutory resumption that Blue Cross engaged in a reasonable effort to obtain relevant facts.
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