Text Size

A A A  
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

Reporting Health Care-Related Civil Judgments

Federal and State attorneys and health plans must report civil judgments related to the delivery of a health care item or service against health care practitioners, providers, or suppliers, regardless of whether the civil judgment is the subject of a pending appeal. NPDB regulations define civil judgment as "a court-ordered action rendered in a Federal or State court proceeding, other than a criminal proceeding. This reporting requirement does not include consent judgments that have been agreed upon and entered to provide security for civil settlements in which there was no finding or admission of liability." Settlements in which no findings of liability have been made are statutorily excluded from being reported. However, actions that occur in conjunction with settlements in which no findings of liability have been made and that otherwise meet NPDB reporting requirements must be reported.

Additionally, actions made with respect to medical malpractice claims should not be reported as civil judgments, but any payment made for the benefit of a health care practitioner in settlement of a medical malpractice claim or judgment must be reported to the NPDB by the medical malpractice payer.

Table E-23 outlines reporting obligations for health care-related civil judgments.

Law Who Reports? What is Reported? Who is Reported?
Section 1921 State attorneys Health care-related civil judgments in State court Practitioners, providers, and suppliers
Section 1128E Federal attorneys

Health plans
Health care-related civil judgments in Federal or State court Practitioners, providers, and suppliers

Table E-24 provides guidance on when health care-related civil judgments must be reported to the NPDB.

Action
Reportable?
A judgment is entered against a clinical laboratory, resulting in a $10,000 award for fraudulent billing and misleading marketing in a suit brought by health insurers and health care payers. Yes
A judgment imposes a $40,000 fine on a medical supplies company for hiring discrimination. No
A judgment against a nursing home imposes a $50,000 fine for neglect and for failure to adequately clean patients' rooms. Yes
A judgment against an ambulance company results in a $30,000 fine for filing false claims and receiving payments for ambulance transportation in cases that were not medically necessary and for patients whose ambulatory status did not require such transportation. Yes
A judgment is entered against a practitioner stemming from an automobile accident not related to the delivery of a health care item or service. No

If a Government agency is party to a multi-claimant civil judgment (that is, more than one party has been awarded an amount because of the civil judgment), it must assume the responsibility for reporting the entire action, including all amounts awarded to all the claimants, both public and private. When a Government agency is not a party, but there are multiple health plans as claimants, the health plan that receives the largest award is responsible for reporting the total action for all parties. If more than one health plan receives the largest award, the plans receiving the largest award must work out among themselves which health plan will report to the NPDB for all parties, making sure that one - but only one - report is filed.

In addition to reporting initial health care-related civil judgments, Federal and State attorneys and all health plans also must report any revisions to previously reported actions, including that an action is on appeal. For more information, go to Types of Reports in this chapter.

Sanctions for Failing to Report to the NPDB

If HHS determines that a Federal or State attorney has substantially failed to report information required to be reported to the NPDB, the name of the government agency will be published and made publicly available.

Any health plan that fails to report information on an adverse action required to be reported to the NPDB will be subject to a civil money penalty of up to $25,000 for each such adverse action not reported. Such penalty will be imposed and collected in the same manner as civil money penalties under Section 1128A(a) of the Social Security Act.

Do you have a question about the NPDB Guidebook that you'd like answered?