Kwoun v. Southeast Missouri Professional Standards Review Organization

MORRIS SHEPPARD ARNOLD, District Judge.

The U.S. Department of Health and Human Services (HHS) oversees Medicare payments to doctors and hospitals. See 42 U.S.C. § 902, § 1395kk(a). As part of its oversight responsibilities, HHS is authorized to exclude doctors and hospitals from eligibility for Medicare payments if services have been provided that are substantially in excess of need or fail to meet profes*403sional standards. See 42 U.S.C. § 1395y(d)(l)(C). To determine whether to exclude doctors and hospitals from eligibility, HHS uses reports submitted by regional and statewide peer review…