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What You Must Report to the NPDB

The NPDB collects information and maintains reports on the following:

  • Medical malpractice payments
  • Federal and state licensure and certification actions
  • Adverse clinical privileges actions
  • Adverse professional society membership actions
  • Negative actions or findings by private accreditation organizations and peer review organizations
  • Health care-related criminal convictions and civil judgments
  • Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
  • Other adjudicated actions or decisions

The reports collected apply to health care practitioners, health care entities, providers and suppliers based on the laws and regulations that govern the National Practitioner Data Bank (NPDB).

Reportable Actions

Table 1. Actions Reportable to the NPDB
Legislation Who Reports? What Information is Reported? Who is Reported
Title IV Medical malpractice payers, including self-insured hospitals and other health care entities Medical malpractice payments made for the benefit of a health care practitioner resulting from a written claim or judgment.

(Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of a payment) 		Practitioners
State Medical and Dental Boards Certain adverse licensure actions related to professional competence or conduct. (Medical and dental boards that meet their reporting requirements for Section 1921, described below, will also meet their requirements to report under Title IV.)

(Reports must be submitted to the NPDB within 30 days of the action) 		Physicians and dentists
Hospitals

Other Health Care Entities with formal peer review 		Professional review actions - based on reasons related to professional competence or conduct - adversely affecting clinical privileges for a period longer than 30 days. Voluntary surrender or restriction of clinical privileges while under, or to avoid, an investigation.

(Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of the action) 		Physicians and dentists

Other practitioners (optional)
Professional societies with formal peer review Professional review actions, based on reasons relating to professional competence or conduct, adversely affecting membership.

(Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of the action) 		Physicians and dentists

Other practitioners (optional)
Drug Enforcement Administration (DEA) DEA controlled substance registration actions*

(Reports must be submitted to the NPDB within 30 days of the action) 		Practitioners
Department of Health and Human Services (HHS) Office of Inspector General Exclusions from participation in Medicare, Medicaid, and other Federal health care programs*

(Exclusions are reported to the NPDB monthly) 		Practitioners
Section 1921 Peer review organizations Negative actions or findings by peer review organizations

(Reports must be submitted to the NPDB and appropriate State Licensing or Certification Authority within 30 days of the action) 		Practitioners
Private accreditation organizations Negative actions or findings by private accreditation organizations

(Reports must be submitted to the NPDB and appropriate State Licensing or Certification Authority within 30 days of the action) 		Health care entities, providers, suppliers
State Licensing and Certification Authorities State licensure and certification actions (resulting from formal proceeding)
  • Adverse actions (including but not limited to revocation, suspension, reprimand, censure, probation)
  • Any dismissal or closure of the proceedings by reason of surrendering the license or certification agreement or contract for participation in a government health care program or leaving the state or jurisdiction
  • Any other loss of - or loss of the right to apply for or renew - a license or certification agreement or contract for participation in a government health care program
  • Any publicly available negative action or finding
(Reports must be submitted to the NPDB within 30 days of the action) 		Practitioners, health care entities, providers, suppliers
State law enforcement agencies**

State Medicaid Fraud Control Units**

State agencies administering or supervising the administration of a state health care program** 		Exclusions from participation in a state health care program

Health care-related civil judgments in state court

Health care-related state criminal convictions

Other adjudicated actions or decisions (related to the payment, provision, or delivery of a health care item or service)

(Reports must be submitted to the NPDB within 30 days of the action) 		Practitioners, providers, suppliers
Section 1128E Federal Government agencies

Health plans		 Federal licensure and certification actions***
  • Formal or official actions (including but not limited to revocation, suspension, reprimand, censure or probation)
  • Any dismissal or closure of the proceedings by reason of surrendering the license or certification agreement or contract for participation in a government health care program or leaving the state or jurisdiction
  • Any other loss of - or loss of the right to apply for or renew - a license or certification agreement or contract for participation in a government health care program
  • Any publicly available negative action or finding

Health care-related civil judgments in Federal or state court

Health care-related criminal convictions in Federal or state court***

Exclusions from participation in a Federal health care program***

Other adjudicated actions or decisions (related to the payment, provision, or delivery of a health care item or service)

(Reports must be submitted to the NPDB within 30 days of the action.) 		Practitioners, providers, suppliers

* This information is reported to the NPDB under Title IV based on a Federal cooperative agreement.
** The NPDB regulations define "state law or fraud enforcement agency" to include but not be limited to these entities. The information that is reported by each entity may differ by state depending on the state structure.
*** Reported only by Federal Government agencies.

Sanctions for Failing to Report to the NPDB

  • Any malpractice payer that fails to report medical malpractice payments is subject to a civil money penalty of up to $23,331 for each such payment involved.
  • Any hospital or other health care entity that fails substantially to report adverse actions will have its name published in the Federal Register, and the organization will lose its immunity from liability 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.
  • Any State Medical or Dental Board that fails to submit reports of adverse actions can have the responsibility to report removed by the Secretary of HHS.
  • Any professional society that fails substantially to report adverse membership actions can lose immunity protections provided under Title IV for 3 years.
  • Any health plan that fails to report information on an adverse action required to be reported to the NPDB shall be subject to a civil money penalty of up to $39,811 for each adverse action not reported.
  • The Secretary of HHS shall publish a public report that identifies those government agencies that have failed to report information on adverse actions as required.

See the Guidebook for additional details.


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