U.S. v. Aurora Health Care, Inc. – March 2015 (Summary)

PEER REVIEW PRIVILEGE

U.S. v. Aurora Health Care, Inc., No. 14-MC-77 (E.D. Wis. Mar. 20, 2015)

This case arose out of an investigation by the United States government into whether a hospital had knowingly submitted false claims for reimbursement to federal healthcare programs. The government had subpoenaed the hospital for production of certain relevant documents, but the hospital had refused to turn over files that related to the peer review and evaluation of its health care providers.

Weighing the interest of both parties, the court noted that the government’s claim against the hospital did not allege any particular misuse of the peer review process itself. However, it reasoned that blocking access to these materials could hinder the investigation that was already underway, especially since some of the materials might reveal whether the hospital knew its physicians were submitting false claims.

The court ultimately decided in favor of the government. It concluded that participants in peer review proceedings usually understand that their comments may be disclosed under certain circumstances, whether to the individual under review or to government officials, and reasoned that disclosure under these circumstances would probably not cause any deterioration of peer review proceedings. The court refused to apply the peer review privilege to protect these documents and ordered the hospital to comply with the subpoena. For the same reasons, the court declined to recognize a similar self-critical review privilege. However, the court did note that the hospital would not be liable under state law for disclosing this information, since it was obeying the order of a federal court.