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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 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?

    No. While health plans are required to report actions that meet the definition of an "other adjudicated action or decision," that definition specifically excludes business or administrative decisions by health plans that result in contract terminations unrelated to health care fraud, or abuse, or quality of care issues. The contract terminations taken by this health plan were based on business decisions regarding its network and were not related to health care fraud, or abuse, or the quality of health care delivered by the practitioners involved.

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