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U.S. Code as of:
01/19/04
Section 1320c-9. Prohibition against disclosure of information
(a) Freedom of Information Act inapplicable; exceptions to
nondisclosure
An organization, in carrying out its functions under a contract
entered into under this part, shall not be a Federal agency for
purposes of the provisions of section 552 of title 5 (commonly
referred to as the Freedom of Information Act). Any data or
information acquired by any such organization in the exercise of
its duties and functions shall be held in confidence and shall not
be disclosed to any person except -
(1) to the extent that may be necessary to carry out the
purposes of this part,
(2) in such cases and under such circumstances as the Secretary
shall by regulations provide to assure adequate protection of the
rights and interests of patients, health care practitioners, or
providers of health care, or
(3) in accordance with subsection (b) of this section.
(b) Disclosure of information permitted
An organization having a contract with the Secretary under this
part shall provide in accordance with procedures and safeguards
established by the Secretary, data and information -
(1) which may identify specific providers or practitioners as
may be necessary -
(A) to assist Federal and State agencies recognized by the
Secretary as having responsibility for identifying and
investigating cases or patterns of fraud or abuse, which data
and information shall be provided by the peer review
organization to any such agency at the request of such agency
relating to a specific case or pattern;
(B) to assist appropriate Federal and State agencies
recognized by the Secretary as having responsibility for
identifying cases or patterns involving risks to the public
health, which data and information shall be provided by the
peer review organization to any such agency -
(i) at the discretion of the peer review organization, at
the request of such agency relating to a specific case or
pattern with respect to which such agency has made a finding,
or has a reasonable belief, that there may be a substantial
risk to the public health, or
(ii) upon a finding by, or the reasonable belief of, the
peer review organization that there may be a substantial risk
to the public health;
(C) to assist appropriate State agencies recognized by the
Secretary as having responsibility for licensing or
certification of providers or practitioners or to assist
national accreditation bodies acting pursuant to section 1395bb
of this title in accrediting providers for purposes of meeting
the conditions described in subchapter XVIII of this chapter,
which data and information shall be provided by the peer review
organization to any such agency or body at the request of such
agency or body relating to a specific case or to a possible
pattern of substandard care, but only to the extent that such
data and information are required by the agency or body to
carry out its respective function which is within the
jurisdiction of the agency or body under State law or under
section 1395bb of this title; and
(D) to provide notice in accordance with section
1320c-3(a)(9)(B) of this title;
(2) to assist the Secretary, and such Federal and State
agencies recognized by the Secretary as having health planning or
related responsibilities under Federal or State law (including
health systems agencies and State health planning and development
agencies), in carrying out appropriate health care planning and
related activities, which data and information shall be provided
in such format and manner as may be prescribed by the Secretary
or agreed upon by the responsible Federal and State agencies and
such organization, and shall be in the form of aggregate
statistical data (without explicitly identifying any individual)
on a geographic, institutional, or other basis reflecting the
volume and frequency of services furnished, as well as the
demographic characteristics of the population subject to review
by such organization.
The penalty provided in subsection (c) of this section shall not
apply to the disclosure of any information received under this
subsection, except that such penalty shall apply to the disclosure
(by the agency receiving such information) of any such information
described in paragraph (1) unless such disclosure is made in a
judicial, administrative, or other formal legal proceeding
resulting from an investigation conducted by the agency receiving
the information. An organization may require payment of a
reasonable fee for providing information under this subsection in
response to a request for such information.
(c) Penalties
It shall be unlawful for any person to disclose any such
information described in subsection (a) of this section other than
for the purposes provided in subsections (a) and (b) of this
section, and any person violating the provisions of this section
shall, upon conviction, be fined not more than $1,000, and
imprisoned for not more than 6 months, or both, and shall be
required to pay the costs of prosecution.
(d) Subpoena and discovery proceedings regarding patient records
No patient record in the possession of an organization having a
contract with the Secretary under this part shall be subject to
subpoena or discovery proceedings in a civil action. No document or
other information produced by such an organization in connection
with its deliberations in making determinations under section
1320c-3(a)(1)(B) or 1320c-5(a)(2) of this title shall be subject to
subpoena or discovery in any administrative or civil proceeding;
except that such an organization shall provide, upon request of a
practitioner or other person adversely affected by such a
determination, a summary of the organization's findings and
conclusions in making the determination.
(e) Organizations with contracts
For purposes of this section and section 1320c-6 of this title,
the term "organization with a contract with the Secretary under
this part" includes an entity with a contract with the Secretary
under section 1320c-3(a)(4)(C) of this title.
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