Besides unannounced surveys and ever-changing standards, here's one more thing to worry about when it comes to accreditation: If your facility is targeted by the federal government, authorities may be able to access the records associated with your accreditation inspections.

A federal prosecutor successfully subpoenaed The Joint Commission for all audit documents, reports of findings and supporting materials from site visits between 2006 and August 2009 of the The Headache & Pain Center in Leawood, Kans., which is under investigation for potential federal healthcare offenses.

In an agreement with prosecutors, The Joint Commission stated that Illinois state law prevented it from releasing the records voluntarily, but it would supply the information if the federal court in which the U.S. Attorney filed the motion ordered it to do so.

"The Joint Commission treats very, very seriously and fights in every way reasonable and possible to protect the confidentiality of confidential accreditation documents," says Harold J. Bressler, JD, the organization's general counsel.

State laws offer extensive protections, but federal law supersede these, and on the rare occasions when federal authorities request documents — in 2 decades with The Joint Commission, Mr. Bressler has seen few — the organization demands an agreed-upon court order.

"Most people would be surprised that we take the step of requiring this additional order instead of just complying with a federal subpoena, but we insist on it," says Mr. Bressler.

The order includes such provisions as the ability to redact patient names, the exclusion of sentinel event-related communication and strict limits on the disclosure of the information.

"It's provisions like that that lead us to want these orders instead of just complying with the subpoenas," says Mr. Bressler. "The fact that we have a few of these orders outstanding over the years is not evidence that we can't protect the confidentiality of accreditation documents. It's exactly the reverse. It shows how deadly serious we are about protecting them."

The Assistant U.S. Attorney, Lucinda Woolery, declined all comment on the matter. The administrator of The Headache & Pain Center did not return several calls seeking comment.

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