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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

Reporting Adverse Professional Society Membership Actions

Professional societies must report professional review actions based on reasons related to professional competence or professional conduct that adversely affect or may adversely affect the membership of a physician or dentist. Professional societies may report such adverse membership actions when taken against health care practitioners other than physicians and dentists.

Table E-7 outlines reporting obligations for professional society membership actions.

Law Who Reports? What is Reported? Who is Reported?
Title IV Professional societies with formal peer review Certain professional society membership actions related to professional competence or conduct Physicians and dentists
Other practitioners (optional)

An action taken by a professional society that adversely affects or may adversely affect a physician's or dentist's membership must be reported to the NPDB when that action is taken in the course of professional review activity through a formal peer review process, provided the action is based on the member's professional competence or professional conduct that adversely affects, or could adversely affect, the health or welfare of a patient. The professional society that takes the adverse action generally determines whether the physician's or dentist's professional competence or professional conduct adversely affects, or could adversely affect, the health or welfare of a patient.

Matters not related to the professional competence or professional conduct of a physician or dentist should not be reported to the NPDB. For example, adverse actions against a practitioner based primarily on his or her advertising practices, fee structure, salary arrangement, affiliation with other associations or health care professionals, or other competitive acts intended to solicit or retain business are excluded from NPDB reporting requirements.

In addition, if censure, reprimand, or admonishment is the sole result of an adverse membership action, that action should not be reported to the NPDB.

Professional societies also must report revisions to previously reported adverse actions. For more information, go to Types of Reports in this chapter.

Table E-8 provides examples of whether specific professional society membership actions must be reported to the NPDB.

Action
Reportable?
A professional society denies membership to a physician after the society's peer review committee found that the physician had failed to obtain required informed consents for several patients. Yes
A professional society denies membership to a dentist who has had his wages garnished for not paying child support. No
A professional society terminates a dentist's membership for failure to pay the annual membership fee. No
A professional society's peer review committee took an action to suspend a physician's membership based on a State licensing board's action to place the physician's license on probation for reasons related to professional conduct that adversely affects, or could adversely affect, the health or welfare of a patient. Yes
A physician resigns a professional society membership or allows the membership to lapse while under a formal peer review investigation by the professional society, but before a final decision is rendered. No

Submitting a Copy of the Report to the State Licensing Board

A copy of the Report Verification Document that professional societies receive after a report is processed successfully by the NPDB must be provided to the appropriate State licensing board in the State in which the professional society is located. Alternatively, NPDB reporters may elect to send an electronic version of the report to the appropriate State licensing board through the NPDB's Electronic Report Forwarding service, provided the State board has agreed to accept electronic notices of an action.

Sanctions for Failing to Report to the NPDB

A professional society that has substantially failed to report adverse membership actions can lose, for 3 years, the immunity protections provided under Title IV for professional review actions it takes against physicians and dentists based on their professional competence and professional conduct.

The Secretary of HHS will conduct an investigation if there is reason to believe that a professional society has substantially failed to report adverse membership actions taken as result of professional review activity. If the investigation reveals that the professional society has not complied with reporting requirements, HHS will inform the professional society of its noncompliance in writing. This written notice provides the professional society with the opportunity to correct the noncompliance and notifies it of its right to request a hearing.

A request for a hearing must contain a statement of the material factual issues in dispute to demonstrate cause for a hearing and must be submitted to HHS within 30 days of receipt of the notice of noncompliance. These issues must be both substantive and relevant. An example of a material factual issue in dispute is a professional society refuting HHS's claim that the professional society failed to meet reporting requirements.

If a request for a hearing is denied if it is untimely or lacks a statement of material factual issues in dispute, or if the statement is frivolous or inconsequential. Hearings are held in the Washington, DC, metropolitan area. If a request for a hearing is denied or if HHS determines that a professional society has substantially failed to report information in accordance with NPDB requirements, the name of the entity will be published in the Federal Register, and the professional society will lose the immunity provisions under Title IV with respect to professional review activities for a period of 3 years, commencing 30 days from the date of publication in the Federal Register.

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