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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 State Licensure and Certification Actions

  1. In some states, an agency other than a licensing board (such as a state department of health) may be responsible for taking actions against unlicensed providers. Are these other agencies required to report the actions they take?

    Yes. NPDB regulations define a board as "a body or subdivision of such body which is designated by a state for the purpose of licensing, monitoring, and disciplining physicians or dentists." 45 CFR § 60.3. A physician or dentist is defined to include anyone "who, without authority, holds himself or herself out to be" authorized by a state to practice medicine, surgery, or dentistry. In addition, the regulations say the term "[s]tate licensing or certification agency includes, but is not limited to, any authority of a state . . . responsible for the licensing or certification of health care practitioners . . . . Examples of such state agencies include Departments of Professional Regulation, Health, Social Services . . . , Commerce, and Insurance" (emphasis added). Thus, for purposes of reporting actions taken against unlicensed providers, agencies other than traditional state licensing boards are treated as state boards and must report to the NPDB if other reporting requirements are met.

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