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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 Other Adjudicated Actions or Decisions

  1. A federal hospital terminated the employment of one of its nurses after an investigation determined that the nurse had physically and verbally abused several patients. The nurse was afforded due process. Should this action be reported to the NPDB?

  2. A health plan terminated contracts with several psychologists in its network because the plan determined it already had too many psychologists in that geographic area. Should this action be reported to the NPDB?

  3. A health maintenance organization (HMO) terminated the contract of one of its physicians for sexually harassing a nurse. The HMO also took a professional review action to revoke the physician's network participation. The HMO's standard operating procedures require that practitioners be afforded due process when contract actions are taken for cause. The standard operating procedures also require a committee of peers to make all network participation determinations. What should be reported to the NPDB?

  4. A health care entity terminated a physician's contract for causes relating to poor patient care, which in turn resulted in loss of network participation. Should this be reported to the NPDB using one or two reports?

  5. After an investigation and formal hearing, a state hospital suspended without pay one of its physician employees after discovering that the physician had misrepresented his credentials on his employment application. Is this reportable?

  6. A health plan determines that a pharmacy had been improperly substituting generic compounds for certain prescribed brand-name drugs and terminates the pharmacy's contract. While reaching its decision, the health plan employed the due process safeguards it had set in place. Is the termination reportable?

  7. After he disclosed conduct to the OIG as part of a settlement agreement, a physician agreed to pay $30,000 for allegedly violating the Civil Monetary Penalties Law. The physician disclosed that he employed an individual who he knew or should have known was excluded from participation in federal health care programs. The settlement did not involve a finding or admission of liability. Should this be reported to the NPDB as an "other adjudicated action or decision"?

  8. The OIG pursued civil money penalties against a hospital for allegedly failing to provide an appropriate medical screening examination and stabilizing treatment. The patient was told to go home and follow orders from his primary care provider. Two days later, the patient went to another hospital's emergency department, was admitted to the intensive care unit, and then died due to H1N1 influenza. The first hospital agreed to pay $25,000 to settle its liability for civil money penalties under the Emergency Medical Treatment and Active Labor Act. The settlement did not include any findings or admission of liability by the hospital. Should this action be reported?

  9. The OIG pursued civil money penalties against a physician because the physician and his medical practice allegedly billed Medicare improperly. The physician appealed the decision to impose a civil money penalty to the HHS Departmental Appeals Board. The administrative law judge assigned to the case found in favor of the OIG and upheld the imposition of the civil money penalty against the physician. Should these money penalties be reported?

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