On July 20, 2018, the U.S. District Court for the District of Columbia dismissed claims against URAC Inc., a Washington, D.C.-based nonprofit healthcare accreditation agency (URAC) by BHM Healthcare Solutions Inc., a for-profit corporation headquartered in Florida (BHM) that “provides medical review services to health insurance plans, healthcare systems, and related administrators and management organizations.”  BHM sued URAC after having its accreditation revoked based on the determination that BHM did not maintain required data integrity, compliance with applicable laws and regulations, and quality standards.  The court ruled that “URAC’s determinations were the product of reasoned decision-making and a fair process.”

With respect to data integrity, URAC determined that independent medical reviewer decisions were subject to change without the reviewer’s knowledge or approval, contrary to BHM’s policy, which required that decisions could only be changed or edited by the system administrator following a strict protocol. 

BHM argued URAC should have consulted with BHM’s Chief Information Officer, instead of opting to speak with the “Compliance Officer and clinical specialists who are not subject matter experts on data integrity and security,” according to the judgment.  However, the Court ruled that URAC acted properly in reviewing a medical review services provider’s data security and wrote that “URAC’s determinations were the product of reasoned decision-making and a fair process.”

The case is BHM Healthcare Sols., Inc. v. URAC, Inc., 2018 BL 258480, D.D.C., No. 18-cv-01119, 7/20/18.  The July 20 opinion is available here.