title: PROs and poor quality medical care--they can't sanction it until they define it!
abstract: This article demonstrates that Professional Review Organizations are required to use objective, scientifically developed "norms," "criteria," and "standards" in evaluating the quality of health care provided to Medicare beneficiaries. The author suggests that most PROs do not do so and, therefore, any PRO's attempt to impose sanctions or deny payment for alleged poor quality is illegal.
mesh_terms: D008485:Medical Audit; D006278:Medicare / Q000592:standards*; D010820:Physicians / Q000592:standards*; D011366:Professional Review Organizations / Q000331:legislation & jurisprudence*; D011787:Quality of Health Care / Q000592:standards*; D012015:Reference Standards; D014481:United States; D014600:Utilization Review