CMS Pub. 100-10, ch. 9, § 9130.1

The QIO should select a physician to review the case who is a specialist (actively

practicing in his/her specialty and, whenever possible, board-certified) in either the

specialty of the physician who attended the patient or the specialty indicated by the

condition of the patient whose care is under review. Whenever possible, the physician

reviewer should practice in a similar setting as that of the physician who attended the

patient.

Select a physician who agrees in writing to conduct the review in accordance with the

requirements in §9130.2 and to testify as an expert witness, if necessary, to properly

adjudicate the case.

NOTE: A QIO is precluded from disclosing information that would identify a QIO

physician reviewer without his/her consent (42 CFR 480.133(a)(2)(iii)). Therefore, the

QIO must ensure that each physician reviewer is aware of the potential need to serve as

expert witnesses and, prior to review of cases, secure a statement of willingness to serve as

an expert witness to certify his/her availability for expert witness testimony. QIOs must

maintain a file containing the names of physician reviewers. Upon request from OIG,

QIOs must provide the names of individuals who reviewed specific medical records to

serve as expert witnesses.