--- kind: "section" citation: "42 U.S.C. § 11151" title: "42" title_heading: "The Public Health and Welfare" number: "11151" heading: "Definitions" release: "119-102" date: "2026-07-12" url: "https://uscodex.org/usc/42/11151" units: - "Chapter 117 — Encouraging Good Faith Professional Review Activities" - "Subchapter III — Definitions and Reports" --- # §11151. Definitions In this chapter: - (1) The term “adversely affecting” includes reducing, restricting, suspending, revoking, denying, or failing to renew [clinical privileges](#3) or membership in a [health care entity](#4-A). - (2) The term “Board of Medical Examiners” includes a body comparable to such a Board (as determined by the [State](#13)) with responsibility for the licensing of [physicians](#8) and also includes a subdivision of such a Board or body. - (3) The term “clinical privileges” includes privileges, membership on the medical staff, and the other circumstances pertaining to the furnishing of medical care under which a [physician](#8) or other [licensed health care practitioner](#6) is permitted to furnish such care by a [health care entity](#4-A). - (4) - (A) The term “health care entity” means— - (i) a [hospital](#5) that is licensed to provide health care services by the [State](#13) in which it is located, - (ii) an entity (including a health maintenance organization or group medical practice) that provides health care services and that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the [Secretary](#12)), and - (iii) subject to [subparagraph (B)](#4-B), a professional society (or committee thereof) of [physicians](#8) or other [licensed health care practitioners](#6) that follows a formal peer review process for the purpose of furthering quality health care (as determined under regulations of the [Secretary](#12)). - (B) The term “[health care entity](#4-A)” does not include a professional society (or committee thereof) if, within the previous 5 years, the society has been found by the Federal Trade Commission or any court to have engaged in any anti-competitive practice which had the effect of restricting the practice of [licensed health care practitioners](#6). - (5) The term “hospital” means an entity described in paragraphs (1) and (7) of [section 1395x(e) of this title](/usc/42/1395x.md?p=e). - (6) The terms “licensed health care practitioner” and “practitioner” mean, with respect to a [State](#13), an individual (other than a [physician](#8)) who is licensed or otherwise authorized by the [State](#13) to provide health care services. - (7) The term “medical malpractice action or claim” means a written claim or demand for payment based on a health care provider’s furnishing (or failure to furnish) health care services, and includes the filing of a cause of action, based on the law of tort, brought in any court of any [State](#13) or the United States seeking monetary damages. - (8) The term “physician” means a doctor of medicine or osteopathy or a doctor of dental surgery or medical dentistry legally authorized to practice medicine and surgery or dentistry by a [State](#13) (or any individual who, without authority holds himself or herself out to be so authorized). - (9) The term “professional review action” means an action or recommendation of a [professional review body](#11) which is taken or made in the conduct of [professional review activity](#10), which is based on the competence or professional conduct of an individual [physician](#8) (which conduct affects or could affect adversely the health or welfare of a patient or patients), and which affects (or may affect) adversely the [clinical privileges](#3), or membership in a professional society, of the [physician](#8). Such term includes a formal decision of a [professional review body](#11) not to take an action or make a recommendation described in the previous sentence and also includes [professional review activities](#10) relating to a professional review action. In this chapter, an action is not considered to be based on the competence or professional conduct of a [physician](#8) if the action is primarily based on— - (A) the [physician](#8)’s association, or lack of association, with a professional society or association, - (B) the [physician](#8)’s fees or the [physician](#8)’s advertising or engaging in other competitive acts intended to solicit or retain business, - (C) the [physician](#8)’s participation in prepaid group health plans, salaried employment, or any other manner of delivering health services whether on a fee-for-service or other basis, - (D) a [physician](#8)’s association with, supervision of, delegation of authority to, support for, training of, or participation in a private group practice with, a member or members of a particular class of health care [practitioner](#6) or professional, or - (E) any other matter that does not relate to the competence or professional conduct of a [physician](#8). - (10) The term “professional review activity” means an activity of a [health care entity](#4-A) with respect to an individual [physician](#8)— - (A) to determine whether the [physician](#8) may have [clinical privileges](#3) with respect to, or membership in, the entity, - (B) to determine the scope or conditions of such privileges or membership, or - (C) to change or modify such privileges or membership. - (11) The term “professional review body” means a [health care entity](#4-A) and the governing body or any committee of a [health care entity](#4-A) which conducts [professional review activity](#10), and includes any committee of the medical staff of such an entity when assisting the governing body in a [professional review activity](#10). - (12) The term “Secretary” means the Secretary of Health and Human Services. - (13) The term “State” means the 50 States, the District of Columbia, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. - (14) The term “State licensing board” means, with respect to a [physician](#8) or health care provider in a [State](#13), the [agency](/usc/42/8262.md?p=1) of the [State](#13) which is primarily responsible for the licensing of the [physician](#8) or provider to furnish health care services. ## Source credit (Pub. L. 99–660, title IV, § 431, Nov. 14, 1986, 100 Stat. 3792.)