Title 42, The Public Health and WelfareRelease 119-110

§11112 Standards for Professional Review Actions

Title 42 › CHAPTER 117 — ENCOURAGING GOOD FAITH PROFESSIONAL REVIEW ACTIVITIES › SUBCHAPTER I — PROMOTION OF PROFESSIONAL REVIEW ACTIVITIES › § 11112

Last updated Sep 22, 2026|Official source

Summary

A professional review action must be taken only when the people doing it reasonably believe it will help improve patient care, after they try to find the facts, after the doctor is given fair notice and a chance for a hearing (or other fair procedures), and when they reasonably believe the action is supported by the facts found. Such an action is assumed to meet these rules unless it is shown, by more likely than not, that it did not. A doctor meets the “adequate notice and hearing” rule if they get a written notice saying a professional action is proposed, the reasons, that the doctor can ask for a hearing, the deadline to request a hearing (not less than 30 days), and a summary of hearing rights. If a hearing is timely requested, the doctor must get notice of the place, date, and time (at least 30 days later) and expected witnesses. The hearing can be before a mutually agreed arbitrator, an entity-appointed officer not in direct competition with the doctor, or a similar panel. The doctor may lose the hearing right for not showing up without good cause. At the hearing the doctor may have a lawyer, make a record and get copies, call and cross-examine witnesses, present relevant evidence, and give a written closing statement. Afterward the doctor gets the recommendation and the entity’s written decision with reasons. These hearing rules do not apply if no adverse action is taken, during a short suspension or restriction of up to 14 days while investigating, or when immediate action is needed to prevent an imminent danger, provided notice and a hearing follow.

Full Legal Text

Title 42, §11112

The Public Health and Welfare, Source: USLM XML via OLRC

(a)In general

For 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 hearing

A 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 action

The 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 hearing

If 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 notice

If 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 emergencies

For 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.

Reference

Citations & Metadata

Citation

42 U.S.C. § 11112

Title 42, The Public Health and Welfare

Last Updated

Sep 22, 2026

Release point: 119-110