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Health care services review; confidentiality of information – Wis. Stat. Ann. § 146.38

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Wisconsin prohibits persons and organizations that conduct health care provider quality or utilization reviews from maintaining records related to any “investigations, inquiries, proceedings, and conclusions” that occur as part of a review. Additionally, quality and utilization review records may not accessed by the subject matter of the record. Persons that participate in a quality or utilization review may not testify about information discussed during the review unless they obtained the information apart from their participation in the review.

 Health care review information, including patient identities, may be disclosed, in accordance with the law, (1) to the health care provider under review; (2) “to any person with the consent of the health care provider” under review;” (3) to a person that requests review so long as they use the information to improve quality, avoid improper use, and determine appropriate charges for services; (4) to a court that subpoenas the information in relation to a charge of sexual exploitation by a therapist; and (5) to a licensing board or agency if the reviewing party believes such disclosure is appropriate.

A person with the authority to authorize a quality or utilization review may consent to the release of information obtained during such a review to health care provider’s employer or “the parent, subsidiary, or affiliate organization of a health care provider” or their employer. Information disclosed to such persons or entities remains confidential and cannot be used in a criminal or civil proceeding.

Persons that release information or records in violation of this section are liable to any person harmed by the disclosure unless disclosure was due to “a good faith mistake.”

All health care provider specific information obtained by a government agency in relation to quality improvement and resource utilization initiatives is exempt from the public disclosure requirements contained in the law.

Current as of June 2015