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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

Q&A: Reporting Federal or State Health
Care-Related Criminal Convictions

  1. 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?

  2. 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?

  3. 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?

  4. 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?

  5. 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?

  6. The U.S. Department of Justice (DOJ) pursued a criminal health care fraud case against a physician for billing for services that were not provided as claimed. The physician pleaded guilty to health care fraud. In addition, 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?

  7. 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?

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