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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. 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?

    The criminal conviction of the health care practitioner is related to the delivery of a health care item or service and, therefore, the DOJ should report this as a criminal conviction. The OIG must separately report the exclusion. Exclusions from participation in a Federal or State health care program should be reported as an exclusion.

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