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Overview Submitting Reports to the NPDB Reporting Medical Malpractice Payments Reporting Adverse Clinical Privileges Actions Reporting Adverse Professional Society Membership Actions Reporting State Licensure and Certification Actions Reporting Federal Licensure and Certification Actions Reporting Peer Review Organization Negative Actions or Findings Reporting Private Accreditation Organizations Negative Actions or Findings Reporting Exclusions from Participation in Federal and State Health Care Programs Reporting Federal or State Health Care-Related Criminal Convictions Reporting Health Care-Related Civil Judgments Reporting Other Adjudicated Actions or Decisions

Chapter C: Subjects of Reports

Overview

The NPDB is an information clearinghouse created by Congress with the primary goals of improving health care quality, protecting the public, and reducing health care fraud and abuse in the United States. The NPDB collects information on medical malpractice payments and certain adverse actions and discloses that information to eligible entities to facilitate comprehensive reviews of the credentials of health care practitioners, entities, providers, and suppliers. These payments and actions are required to be reported to the NPDB under Title IV of Public Law 99- 660, the Health Care Quality Improvement Act of 1986 (Title IV); Section 1921 of the Social Security Act (Section 1921); Section 1128E of the Social Security Act (Section 1128E); and their implementing regulations found at 45 CFR Part 60.

Identifying terms used by the NPDB are not intended to describe distinct, mutually exclusive categories, nor are the examples provided intended to be exhaustive.

NPDB information is intended to be used in combination with information from other sources in making employment, certification, licensure, clinical privilege, affiliation, or other decisions. Entities that are authorized to report to or query the NPDB include medical malpractice payers, hospitals and other health care entities, professional societies, health plans, peer review organizations, private accreditation organizations, and certain Federal and State agencies. In addition, health care practitioners, entities, providers, and suppliers may request information concerning themselves from the NPDB.

The terms "physician," "dentist," "health care practitioner," "health care entity," "health care provider," and "health care supplier" are not intended to describe distinct, mutually exclusive categories, nor are the examples provided intended to be exhaustive. For example, a skilled nursing facility is an institutional provider, but also can be a supplier of health care items and equipment.

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