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Q&A: Reporting Federal or State Health Care-Related Criminal Convictions
- If a health care practitioner is convicted of a health care-related offense, a report must be submitted to the NPDB within 30 days. Does the 30 days begin when the individual is convicted or when the individual is sentenced?
- A health plan's CEO is convicted of embezzlement from the health plan and is sentenced to 4 years in prison. Should this be reported to the NPDB?
- A health care practitioner pleaded nolo contendere to fraud related to a claim he made on his homeowner's insurance. Should this be reported to the NPDB?
- A physician accepted small sums of money for making referrals to a specialist. The offense resulted in a deferred conviction, under which the physician must satisfy a 2-year probationary period before the conviction is dropped. Should this be reported to the NPDB?
- A chiropractor accepted kickbacks from a medical supply company in exchange for patient referrals. Both the chiropractor and the medical supply company were convicted and each was sentenced to a fine of $20,000. Should both convictions be reported in one report?
- The Department of Justice (DOJ) pursued a criminal health care fraud case against a physician for billing for unprovided services. The physician pleaded guilty to health care fraud. Then, the OIG excluded the physician from participating in federal health care programs due to his criminal conviction of an offense related to fraud in connection with the delivery of a health care item or service. How should this be reported to the NPDB?
- A state court imposed an injunction on a medical equipment supplier to prevent the supplier from selling certain medical devices that may be faulty. The supplier plans to appeal the decision. Should the reporting entity wait until after the appeal to make a determination about submitting a report to the NPDB?
- A health care practitioner enters a pretrial intervention program after being charged with a crime related to the delivery of a health care item or service. The practitioner never enters a plea in the criminal case, and no adjudication occurs. As part of the intervention program, the practitioner is required to pay restitution, but this payment is not considered a fine. A state statute involved in this case gives a state official, at the end of the intervention period, the power to recommend whether the criminal case should proceed through normal channels or be dismissed. Must the state prosecutor involved in the case report to the NPDB the practitioner's entry into the pretrial intervention program, even though no adjudication occurred?
