Health Care Counsel

Arent Fox's health care law blog offers news, analysis, and insights for the health care industry.

Health Care Counsel
Litigation & Alternative Dispute Resolution, Medical Staff Credentialing & Peer Review Law
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Michalski v. Scripps Mercy Hospital: A Win for Both Peer Reviewers and Hospital Boards

Earlier this month, Arent Fox Health Care partner Lowell C. Brown  published an article in California Healthcare News that provides insight into a key peer review case involving legal principles and individual behaviors that provide critical lessons for hospitals.

In the article, Mr. Brown reports that “Michalski was about sexual harassment, an errant hearing committee decision, and a governing body’s ultimate authority to decide what physician behavior is acceptable in the hospital. In its decision the California Court of Appeal confirmed that a hospital’s governing body may, where permitted by the hospital’s medical staff bylaws, broadly exercise its independent judgment and overturn a Judicial Review Committee (JRC) decision following a peer review hearing.”

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Payer Disputes & Reimbursement
RAC Audits are Becoming Increasingly Frequent and Costly to Hospitals but Appeals can Succeed

The latest report published by the American Hospital Association (AHA) detailing the results of its RAC Trac survey1 reveals that RAC activity in hospitals has significantly increased in 2013. Not surprisingly, the financial impact of this increased RAC activity has grown substantially as well, both in terms of claims denials and the costs associated with responding to the RACs. Nevertheless, hospitals that have challenged denials of claims by RACs, either through the appeal process or through utilization of the discussion period, have had significant success in overturning denials.

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