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Q&A: Reporting Other Adjudicated Actions or Decisions
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?
The HMO must submit two separate reports to the NPDB. The contract termination must be reported to the NPDB because it meets the definition of an "other adjudicated action or decision." The HMO should report the contract termination as a Health Plan Action on the NPDB's Adverse Action Report format. The HMO also should separately report to the NPDB the revocation of network participation because it is a professional review action based on the physician's professional competence or conduct. This action should be reported as a Clinical Privileges Action on the Adverse Action Report format. NPDB governing laws and regulations require that clinical privileges actions (including network participation) and other adjudicated actions or decisions be reported to the NPDB separately.
