When paper charts were the norm, a common question was how long you are required to keep medical records. Paper charts took up space. The more records you had, the more file cabinets you needed. And if the records spilled over, you needed to place such documents in storage. That storage facility had to be secure. And you’d need reasonable access.

With digital records, the space requirement moved to digital. While hard disc space is seemingly unlimited, it isn’t. There’s a cost per GB. And, the larger the database, the slower access to individual records may be. Finally, unlike paper records, if you lose a hard disc, you may lose everything if backup was not performed or failed.

State law, regulation, or Board policy determine how long you must keep medical records.

Statute:
Arizona:

Ariz. Rev. Stat. § 12-2297. For physicians,
Adult patients 6 years after the last date of services from the provider.
Minor patients 6 years after the last date of services from the provider, or until patient reaches the age of 21 whichever is longer.

Regulation:
District of Columbia

D.C. Mun. Regs. tit. 17 § 4612
A licensed physician shall maintain a record for each patient that accurately reflects the evaluation and treatment of each patient. These records shall be kept for three (3) years after last seeing the patient, or three (3) years after a minor patient reaches eighteen (18) years of age.

Board of Medicine:
Oregon:

You are advised to keep patient records, including those of deceased patients, for a minimum of ten years after the patient’s last contact with the licensee.  If space permits, indefinitely retain records of all living patients.  This is not a Board requirement, but this guideline will help you meet the Oregon Statute of limitations.
Note, this appears more of a suggestion than a requirement.

Some states, like California, only speak of hospital retention of records, and not physician retention of records.

Cal. Code Regs. Tit. 22, § 70751 addresses health facilities.
Patient records including X-ray films or reproduction thereof shall be preserved safely for a minimum of seven years following discharge of the patient, except that the records of unemancipated minors shall be kept at least one year after such minor has reached the age of 18 years and, in any case, not less than seven years.

What’s in it for the doctor? Well, retention of records may actually protect YOU. If you are sued, you will need/want the medical records to defend your care.

And a case can be made for hanging on to records for at least ten years. That case was the 2019 Supreme Court ruling, Cochise Consultancy Inc. v. United States, ex rel. Hunt. The Cochise case dealt with the federal False Claims Act – which is triggered by filing false claims for reimbursement, for example, to Medicare and Medicaid. These false claims require knowledge – knowledge means “actual knowledge” or “deliberate ignorance.” Actual knowledge equates to intentional fraud. An example of deliberate ignorance or willful blindness (a lower standard) is coding all E/M visits as level 5 without verifying the visits meet those requirements.

The False Claims Act (FCA) can trigger civil and criminal penalties. Money and/or prison.

Getting into the weeds on the Cochise case:

The result of Cochise’s medical record retention law hinges on interpretation of the FCA statute of limitations/repose. Here’s how:

1. The private citizen in the case (Hunt) filed a qui tam (whistleblower) complaint against Cochise Consultancy. He filed the claim more than six years after the incident in question allegedly occurred, but less than three years after he notified a government official.
   
2. The government opted not to intervene in the case, leaving the litigation to Hunt.
3. Because of that, Cochise argued that only the 6-year statute of limitations applied. Hunt’s claim exceeded that 6-year statute of limitations, so if the court ruled in favor of Cochise, it would mean that the FCA violation claim was no longer valid.
4. The court disagreed with Cochise. They ruled that Hunt filed within three years of notifying a government official—even though the government didn’t intervene—and within 10 years of the alleged violation.
5. They also clarified that knowledge of a violation by a private citizen does not trigger the three-year statute of limitations. Therefore, Hunt’s claim against Cochise was valid.

So, if you ever need to defend against an allegation triggered by the False Claims Act, the ten-year period will rule.

Given how painless it is to maintain digital records, the general recommendation is to keep records for a minimum of 10 years or whatever your state law mandates, which is longer.

What do you think?

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.