Mathews v Lancaster addresses HCQIA. Under HCQIA, who bears the burden to prove bad faith in peer review?

• A. Physician
• B. Hospital
• C. Board
• D. Patient

Answer: (A)

Under HCQIA, actions taken in the professional review process are immune from damages unless bad faith is shown. The burden to prove that bad faith occurred falls on the party bringing the claim, i.e., the plaintiff. In the typical HCQIA challenge, the physician who sues to challenge a peer-review decision must prove the action was not taken in good faith or was performed with malice or a lack of reasonable basis. The hospital or board performs the peer review, but they aren’t the ones who carry the burden to prove bad faith—the claimant does. This standard aligns with Mathews v. Lancaster, which reinforces that the burden rests with the plaintiff to establish bad faith to overcome immunity.