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Is It Reportable? Reporting Scenarios Webcast

The Is It Reportable? Reporting Scenarios Webcast was held on November 16, 2021.

Watch the recording for the Reporting Scenarios Webcast exit icon (video - 57:47)

Event Materials: Presentation Slides (PDF - 555 KB)

Q&As

  1. We have multiple entities at our health system. I am told that we have to run separate NPDB's for each entity. Can you explain why the NPDB cannot be run as a single report when credentialing for all entities at one time?
    Whether your health system needs to run separate NPDB queries for each facility within the system depends upon whether your system has centralized or decentralized credentialing. If a health care system conducts its credentialing centrally, has a centralized peer review process, and has one decision-making body, the health care system may query the NPDB once on each practitioner during the professional review process, regardless of whether the practitioner provides health care services in one or multiple entities. However, if the system's health care entities each conduct their own credentialing, and each health care entity grants privileges to provide health care services only in its facility, each health care entity must query the NPDB separately on its own practitioners.

  2. A primary insurance company made a payment on behalf of a doctor. If an excess carrier reimbursed the primary insurance company, does the excess insurance company have to report to NPDB as well?
    Any medical malpractice payer that makes an indemnity payment for the benefit of a practitioner must submit a report to the NPDB. Generally, primary insurers and excess insurers are obligated to make an indemnity payment for the benefit of a practitioner and so must submit a report to the NPDB. Typically, reinsurers are obligated to make an indemnity payment directly to the primary insurer, not for the benefit of the practitioner, and are not required to submit a report to the NPDB.
    Example: If three primary insurers contribute to a payment, all three insurers are required to submit separate reports to the NPDB. Each insurer should describe the basis for its payment in the narrative description of the settlement to avoid the impression of duplicate reporting.

  3. What is the reporting timeframe?
    Eligible entities must report medical malpractice payments and other required actions to the NPDB within 30 calendar days of the date the action was taken or the payment was made. However, if an eligible entity discovers documentation of medical malpractice payments, adverse actions, or judgments or convictions that the eligible entity had not reported to the NPDB, the entity must promptly submit the related report(s). All required reports must be filed with the NPDB regardless of whether they are late.

  4. When reporting licensure probation, if there are recovery costs ordered as part of the probation, should the amount of recovery cost be reported?
    State licensing and certification authorities must report to the NPDB all money penalties and administrative fines that are adverse actions resulting from a formal proceeding (e.g., formal disciplinary actions) against health care practitioners, entities, providers, and suppliers. However, fines that are considered administrative or technical in nature must be reported to the NPDB only if they meet the NPDB definition of negative actions or findings.

  5. Can you clarify when a notice of intent is to be reported to the NPDB? And who reports this? Please clarify, does this trigger a reportable event, but not a report to the NPDB until the action is taken i.e. payment or settlement?
    The trigger for a report is when an entity makes a payment for the benefit of a health care practitioner in settlement of, or in satisfaction in whole or in part of, a written claim or judgment for medical malpractice against that practitioner, that entity must report the payment information to the NPDB. In order to be reportable, the practitioner must be named, identified, or otherwise described in both the written complaint or claim demanding monetary payment for damages and the settlement release or final adjudication, if any.
    The notice of intent scenario discussed was used to illustrate that the given name of the practitioner does not have to appear in the complaint, release, or final adjudication as long as the practitioner is sufficiently described as to be identifiable. A practitioner may be sufficiently identified by title or role in a procedure, such as "chief of surgery" or "the anesthetist who participated in the patient's surgery," without being specifically named.

  6. When something is reported, does the NPDB review the information to ensure it is accurate and meets reporting requirements prior to releasing it in a query response?
    In order for the NPDB to review this type of information, it must be elevated by the subject for Dispute Resolution. Reporting entities are responsible for the accuracy of information they report to the NPDB and for keeping information reported to the NPDB up to date. Reports submitted to the NPDB are permanently maintained unless corrected or voided by the reporting entity or by the NPDB through the Dispute Resolution process.

  7. Is resignation the same as failing to renew privileges?
    Generally, neither employment resignation nor a failure to renew privileges would trigger a reportable event. However, a surrender/resignation of clinical privileges or a failure to renew clinical privileges while under investigation or to avoid investigation must be reported to the NPDB.

Reporting Scenarios

Reporting Clinical Privileges

Dr. S, a board-certified dentist, owns and operates a small dental clinic in Florida. She also holds a dental license in Maine. Due to her busy schedule, Dr. S forgot to renew her Maine license, which was required to be renewed by March 2021. Once Dr. S' Maine license lapsed, the Maine Dental Board's licensing system automatically suspended the license without confirmation or approval from the state licensing board and placed the license in inactive status.

A few months later at her clinic in Florida, Dr. S was treating a senior citizen for an emergency tooth extraction, which required placing the patient under general anesthesia. The patient experienced severe complications and went into cardiac arrest. The patient sustained a chronic disability and required long-term hospitalization.

After a thorough investigation, the Florida State Licensing Board (the Board) informed Dr. S that she was facing discipline due to the Board's claim that her "...negligence resulted in the harm of a patient." On May 1, 2021, Dr. S signed an agreement with the Board to suspend her Florida license to practice dentistry for a period of 20 days. At the end of 20 days, Dr. S could request to have her license reinstated. The Board reported the suspension to the NPDB as an initial action.

On May 21, 2021, Dr. S petitioned the Board to have her license reinstated. The Board granted Dr. S' request and issued a board order placing Dr. S on probation for two years. The Board also issued Dr. S a $1,000 administrative fee to pay for the investigation and the Board's legal costs. Both the fee and probation can be found on the Board's website. The Board submitted an initial report to the NPDB for the probation and fee. Dr. S disputed the report with the NPDB stating that the fee is not reportable because it is non-disciplinary.

Reporting Medical Malpractice Payments

Dr. L is an oncologist at the Eding Clinic, a clinic that provides a wide range of medical services and employs 30 other medical professionals. Dr. L and the Eding Clinic are insured by XYZ Liability Insurance Company. Dr. L was treating Patient A for abdominal pain. Although several tests were performed on Patient A, Dr. L failed to find a cause for the pain and simply prescribed an over-the-counter painkiller. One month later, Patient A returned to the Eding Clinic with complaints that the pain had gotten worse. Dr. L eventually diagnosed Patient A with colon cancer. Patient A suffered injury to his colon, which required a number of surgeries. The injury could have been avoided with more advance notice of the diagnosis and earlier treatment.

Patient A hired an attorney. The attorney wrote to the Eding Clinic a notice of intent to sue and requested compensation. The notice stated:

Due to the delayed diagnosis and negligence of the Eding Clinic and the doctor who treated Patient A for abdominal pain at Eding, Patient A suffered serious injury. Patient A is seeking $5,000 in damages for the injuries suffered.

Upon receiving the notice of intent to sue, Dr. L worried about the effect that the bad publicity from a lawsuit could have on her practice, so she decided to settle the claim out of her own pocket. Dr. L paid Patient A the $5,000 in exchange for a written statement from Patient A releasing Dr. L of all legal liability related to the incident.

A week after Dr. L paid the $5,000 to Patient A, she submitted a claim to XYZ Liability Insurance Company. XYZ Liability Insurance Company had a policy that reimbursed policy holders from out-of-pocket expenses up to $5,000, and it sent Dr. L a $5,000 check.

Reporting State Licensure Actions

Dr. X is an obstetrician/gynecologist at Memorial Hospital. He became the subject of a medical staff peer review after complications arose during several of his laparoscopic surgeries. Memorial Hospital sent a sampling of his cases for external peer review to determine whether there was breach of standard of care in his cases. The external peer review outcomes indicated that 75% of his cases did not meet the standard of care. The Medical Executive Committee decided to implement a review of Dr. X's laparoscopic practice to include proctoring of his next 15 cases. While the proctor can make recommendations, the proctor had no authority to take over the cases or veto Dr. X's decisions in those cases.

Several months later, Memorial Hospital received a complaint from a staff member about Dr. X. The staff member was uncomfortable with Dr. X's request that she change the documentation of certain details of a difficult delivery in the patient's medical records. Memorial Hospital began an investigation by interviewing staff and meeting with Dr. X about this specific incident of changing certain details in a patient's medical records. Shortly thereafter, Dr. X submitted his resignation from the medical staff at Memorial Hospital. At the time of his resignation, Dr. X had not yet completed his proctoring requirement.

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