Malpractice record review: questions reviewers and risk teams ask
Short version: 12 questions that come up before a review starts and after the report lands, each answered in a few sentences and linked to the page that covers it in full. Nothing here is legal advice; the statute in your state and your own counsel decide those points.
Limits: Prices, turnarounds and claims come from each provider's own pages or the cited survey and statute, read 2026-11-14. We bought no review from anyone listed and cannot vouch for the quality of any reviewer, and nothing here is legal advice on who may testify in your state.
Scoping the review
What is the difference between record review and standard-of-care review?
Record review is preparation: getting the file into order, building the chronology, listing what is missing and what is duplicated. Standard-of-care review is the opinion that follows: whether each decision met the standard and whether any departure caused harm. The process page runs both, in order.
Who pays for the review in a malpractice case?
The party who retains the reviewer pays. In a claim, defense counsel usually retains the expert, which keeps the work under attorney-client privilege. On the plaintiff side the firm pays and recovers it as a case cost. A hospital pays for peer review out of the risk or medical staff budget. The cost page has the published rates.
Does the reviewer have to be licensed in the state where the case is filed?
Not always, but several states do impose conditions. Florida requires the expert to hold an active license, to practice in the same specialty and to have done so for 3 years before the event. The who reviews page sets out the rules it quotes and the states behind them.
How many pages is a review usually?
There is no usual. 1 admission with imaging can be a few hundred pages, a chronic condition managed for years can be several thousand, and a file that 2 parties produced can double. The page count drives the cost more than anything except the reviewer's hours, so ask for a count and a duplicate check before you agree a fee.
What the reviewer produces
What is an affidavit or certificate of merit, and who signs it?
A sworn statement filed with a complaint in states that require 1, saying a qualified reviewer has read the records and found a reasonable basis for the claim. The reviewer signs, so the review has to be finished before filing. The glossary entry has the working definition.
What should a review report contain?
The questions asked, the records reviewed with date ranges, the records that were missing, the standard applied and its source, each departure with the page that shows it, the causation reasoning, and what new information would change the opinion. The worksheet turns those into a form.
What makes a report weak in deposition?
Findings with no page citation, a standard quoted from today rather than the date of care, an opinion outside the reviewer's recent practice, and a conclusion that does not survive the hindsight test. Each of those is a question the other side will ask, and each has a known remedy in the process.
What if the reviewer finds a deviation that did not cause harm?
Say so. A departure with no causal link is still a finding about care quality, and reporting it separately is what keeps the causation opinion credible. Combining the 2 answers is how a solid review turns into a weak 1 on the stand.
Records, tools and checking
What is a records index, and why does the reviewer ask for 1?
A list of every document in the file with its source, date range and page numbers. It lets the reviewer find gaps before reading, and it becomes the records-reviewed section of the report. If you do not have 1, the reviewer builds it first, which is billable time.
What happens when records arrive after the review has started?
Log them with the date received, re-check the chronology against them, and say in the report which version of the file the opinion rests on. A report that silently absorbs new records is impossible to defend later.
Do we need a business associate agreement before sending records to a vendor?
Yes, if the vendor handles protected health information on your behalf as a covered entity. Ask for the signed BAA before the first upload. The glossary entry covers the term.
Can software do the review?
It can do the preparation: read the file, put events in order, cite pages, list what is missing and draft a report from the reviewer's notes. It should not form the opinion, and ours does not. The Medrecords AI page separates the 2 plainly, and says when another route fits better.
How do you check a reviewer's work before you rely on it?
Open the cited page for every finding the opinion depends on, and a sample of the rest. Check whether the standard quoted was in force on the date of care. Ask what would change the opinion. If the reviewer cannot answer that last question, the opinion is not finished.