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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 Organization Negative Actions or Findings Reporting Exclusions from Participation in Federal or 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

Q&A: Reporting Civil Judgments

  1. A health plan won a civil judgment against a clinical laboratory for submitting false claims. Two other health plans were party to the suit and received larger awards. Should all three health plans submit NPDB reports?

  2. The DOJ pursued a civil False Claims Act case against a physician for billing for services that were not provided as claimed. The physician agreed to pay $35,000 to settle False Claims Act liability. The OIG participated in the settlement and waived its exclusion authority in exchange for an integrity agreement with the physician. In the settlement, the physician neither admitted nor denied liability. Should anything be reported to the NPDB?

  3. A health plan won a civil judgment against a durable medical equipment supply company for submitting false claims, but the durable medical equipment supply company has indicated its intent to appeal the decision. Should a decision to report this action to the NPDB be withheld until after the outcome of the appeal is known?

  4. A nurse practitioner was involved in an automobile accident with a delivery van before arriving at the local health clinic where she worked. The nurse practitioner was found liable for damages in a civil lawsuit. Is the judgment against the nurse practitioner reportable to the NPDB?

  5. In a state civil case, the court fined a professional staffing agency that supplied nurses, therapists, and other licensed health care personnel to hospitals and home health agencies $150,000 and required the agency to pay $325,000 in restitution to a group of local providers for overcharges during a 4-year period. Is this fine reportable to the NPDB?

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