Is It Reportable? Archive

A physician applied for medical staff appointment at a hospital but then withdrew the application before a final decision was made by the hospital's governing body. The physician was not being specifically investigated by the hospital. Should the hospital report the withdrawal to the NPDB?
Featured in the March 2024 NPDB Insights

A state agency responsible for licensing skilled nursing facilities suspended a facility's license after substantiating several serious quality of care complaints against the facility. Is this reportable?
Featured in the February 2024 NPDB Insights

If a practitioner takes a leave of absence from a medical staff and enters a rehabilitation program, must this be reported?
Featured in the January 2024 NPDB Insights

A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. The hospital took a professional review action to deny his renewal application, which the Medical Executive Committee (MEC) considered to be related to the practitioner's professional conduct, even though there was no actual patient harm. Should this be reported to the NPDB?
Featured in the December 2023 NPDB Insights

A managed care organization's peer review panel restricts a nurse practitioner's panel membership for 31 days due to concerns about his ability to perform certain procedures. May this be reported?
Featured in the November 2023 NPDB Insights

An anesthesiologist is hired by the hospital's anesthesia group and receives temporary privileges while his application for clinical privileges is pending the formal review process. After the hospital receives several quality of care-related complaints about the anesthesiologist, the practitioner agrees to resign the temporary privileges and withdraw his application for full privileges in return for the hospital not investigating the complaints. Is this reportable?
Featured in the October 2023 NPDB Insights

After conducting a professional review of a surgeon's competence, a hospital assigned a surgical proctor for 60 days. The surgeon could not perform surgery without being granted approval by the surgical proctor. Is the hospital required to report this action to the NPDB?
Featured in the September 2023 NPDB Insights

Do medical malpractice payers have to report payments made for the benefit of a deceased practitioner?
Featured in the August 2023 NPDB Insights

The authorized submitter for a medical malpractice payer found documentation of reportable payments that were not reported to the NPDB in a timely manner. What should the authorized submitter do?
Featured in the July 2023 NPDB Insights

If a state board that regulates dietitians issues a cease and desist order against a person who is not a registered dietitian but practices as one, is the issuance of the cease and desist order reportable to the NPDB?
Featured in the June 2023 NPDB Insights

Are medical malpractice payers required to report payments made for the benefit of a deceased practitioner?
Featured in the May 2023 NPDB Insights

Is a leave of absence while under investigation considered to be a resignation of privileges that is reportable?
Featured in the April 2023 NPDB Insights

A practitioner is meeting with the state's licensing or certification authority to discuss options for entering into an impaired practitioner program. The practitioner receives a recommendation to enter into the program. Should the practitioner's entry into the program be reported to the NPDB by the licensing or certification authority?
Featured in the March 2023 NPDB Insights

A federal hospital terminated the employment of one of its nurses after an investigation determined that the nurse had physically and verbally abused several patients. The nurse was afforded due process. Should this action be reported to the NPDB?
Featured in the February 2023 NPDB Insights

If a federal agency revokes a laboratory's Clinical Laboratory Improvement Amendments certificate, should the action be reported to the NPDB?
Featured in the January 2023 NPDB Insights

The Drug Enforcement Administration (DEA) denied a physician's application to renew his DEA's registration to prescribe controlled substances because he provided false information on the application. Should this action be reported to the NPDB?
Featured in the December 2022 NPDB Insights

A hospital suspended a physician's clinical privileges for 45 days for failing to complete medical records. Should this action be reported to the NPDB?
Featured in the November 2022 NPDB Insights

A physician who holds clinical privileges at a hospital tests positive for a nonprescribed drug. He enters into a treatment plan, but he continues to practice while gradually working to change his addictive behavior. Is this reportable to the NPDB?
Featured in the October 2022 NPDB Insights

A board of medical examiners initiated an investigation related to a physician's professional conduct. Two weeks later, the physician allowed his license to expire. The physician's license lapsed prior to any proposed agreement or board decision. Does the lapse need to be reported to the NPDB?
Featured in the September 2022 NPDB Insights

A hospital's chief of surgery summarily suspended a physician's privileges for outbursts of anger and throwing instruments in an operating room. Should this action be reported to the NPDB?
Featured in the August 2022 NPDB Insights

After conducting a professional review of a surgeon's competence, a hospital assigned a surgical proctor for 60 days. The surgeon could not perform surgery without being granted approval by the surgical proctor. Is the hospital required to report this action to the NPDB?
Featured in the July 2022 NPDB Insights

A physician is being investigated by a hospital for issues related to professional competence and resigns her clinical privileges. At the time of her resignation she states that she plans to move to a different state. Should the resignation be reported to the NPDB?
Featured in the June 2022 NPDB Insights

A hospital began an investigation of a physician on staff for issues related to professional competence 4 weeks prior to the expiration of the physician's clinical privileges. The physician failed to renew the clinical privileges while the investigation was ongoing. Should this event be reported to the NPDB?
Featured in the May 2022 NPDB Insights

The owner of a medical supply company was found not guilty of violating the False Claims Act in regard to fraudulent Medicare claims, but the U.S. Department of Health and Human Services' Office of Inspector General excluded the company from participating in the Medicare program. Should the exclusion be reported to the NPDB?
Featured in the April 2022 NPDB Insights

A physician member of a hospital medical staff applied for an expansion of clinical privileges. Although the physician met all threshold criteria established by the hospital for the expanded privileges, the physician's department head and the medical staff credentials committee recommended denial of the request for expanded clinical privileges based on their assessment that the physician did not have the clinical competence to perform the additional tests and procedures sought. The hospital's governing body reviewed the case, affirmed the findings and recommendations, and denied the physician's request for reasons relating to professional competence. Does the denial of a request for expanded clinical privileges have to be reported to the NPDB?
Featured in the March 2022 NPDB Insights

A state licensing board is required to report any publicly available negative actions or findings. If a state licensing board does not publish its actions on the board's website, but publishes them in a publicly available monthly newsletter, does the board still have to report the actions to the NPDB?
Featured in the February 2022 NPDB Insights

If a professional society denies membership to a physician, should it be reported to the NPDB?
Featured in the January 2022 NPDB Insights

A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. The hospital took a professional review action to deny his renewal application, which the Medical Executive Committee (MEC) considered to be related to the practitioner's professional conduct, even though there was no actual patient harm. Should this be reported to the NPDB?
Featured in the December 2021 NPDB Insights

A hospital repeatedly reminded a physician to update his medical records in a timely manner. After there was no change in the physician's behavior, the hospital initiated an investigation, which revealed that the physician had more than 300 incomplete medical records. As a result, the hospital took a professional review action to suspend the physician's clinical privileges for 60 days, citing professional misconduct. Because there was no actual patient harm, should this be reported to the NPDB?
Featured in the November 2021 NPDB Insights

If my organization takes an action against a physician or other practitioner for not complying with our COVID-19 vaccination requirements, is it reportable?
Featured in the October 2021 NPDB Insights

If a physician's initial application for clinical privileges is denied or the privileges granted are more limited than those requested, must this be reported to the NPDB?
Featured in the September 2021 NPDB Insights

After an investigation and formal hearing, a state hospital suspended without pay one of its physician employees after discovering that the physician had misrepresented his credentials on his employment application. Is this reportable?
Featured in the August 2021 NPDB Insights

The Department of Health and Human Services Office of Inspector General (OIG) pursued civil money penalties against a physician because the physician and his medical practice allegedly billed Medicare improperly. The physician appealed the decision to impose a civil money penalty to the HHS Departmental Appeals Board. The administrative law judge assigned to the case found in favor of the OIG and upheld the imposition of the civil money penalty against the physician. Should these money penalties be reported?
Featured in the July 2021 NPDB Insights

Is a resignation while subject to a "quality improvement plan" a resignation while under investigation? A quality improvement plan might include a limit on the number of patients a physician can have in a hospital at a time or a requirement that all surgical cases be discussed with the physician's department chair in advance of surgery.
Featured in the June 2021 NPDB Insights

A board of medical examiners initiated an investigation related to a physician's professional conduct. Two weeks later, the physician allowed his license to expire. The physician's license lapsed prior to any proposed agreement or board decision, so must the lapse be reported to the NPDB?
Featured in the May 2021 NPDB Insights

Does a medical malpractice payment have to exceed a certain dollar amount before it is reportable to the NPDB?
Featured in the April 2021 NPDB Insights

A health care entity terminated a physician's contract for cause relating to poor patient care, which in turn resulted in loss of network participation. Should this be reported to the NPDB using one or two reports?
Featured in the March 2021 NPDB Insights

A hospital summarily suspended a physician's clinical privileges to allow sufficient time for allegations of gross negligence to be fully investigated. The day after the summary suspension was imposed, the physician requested an educational leave of absence. If the hospital grants the leave of absence, must the summary suspension be reported to the NPDB?
Featured in the February 2021 NPDB Insights

A federal hospital terminated the employment of one of its nurses after an investigation determined that the nurse had physically and verbally abused several patients. The nurse was afforded due process. Should this action be reported to the NPDB?
Featured in the January 2021 NPDB Insights

A state licensing board issued a formal cease and desist order to an unlicensed practitioner who held herself out to be a licensed psychotherapist. Should the action be reported to the NPDB?
Featured in the December 2020 NPDB Insights

A state Medicaid agency excluded a pharmacy from the state's Medicaid program for submitting false claims. Is this action reportable?
Featured in the November 2020 NPDB Insights

If a state board that regulates dieticians issues a cease and desist order against a person who is not a registered dietitian but who is practicing as one, is the issuance of the cease and desist order reportable to the NPDB?
Featured in the October 2020 NPDB Insights

A defendant health care practitioner agreed to settle a medical malpractice claim in exchange for dismissal from a lawsuit. All parties involved in the lawsuit agreed to the condition. Should the resulting payment be reported to the NPDB?
Featured in the September 2020 NPDB Insights

A state Medicaid agency terminated the contract for participation of one of its Medicaid Managed Care Organizations (MCOs) after holding formal hearings and determining that the MCO had not maintained a sufficient network of providers to meet the state's access and quality requirements. Should the state agency report this action to the NPDB?
Featured in the August 2020 NPDB Insights

A health plan determines that a pharmacy had been improperly substituting generic compounds for certain prescribed brand-name drugs and terminates the pharmacy's contract. While reaching its decision, the health plan employed the due process safeguards it had set in place. Is the termination reportable?
Featured in the July 2020 NPDB Insights

An anesthesiologist is hired by the hospital's anesthesia group and receives temporary privileges while his application for clinical privileges is pending the formal review process. After the hospital receives several quality of care-related complaints about the anesthesiologist, the practitioner agrees to resign the temporary privileges and withdraw his application for full privileges in return for the hospital not investigating his complaints. Is this reportable?
Featured in the June 2020 NPDB Insights

My organization is extremely busy due to the COVID-19 pandemic and is unable to fully conduct investigations and hearings. If we summarily suspend a practitioner's privileges during this time, will the NPDB allow us to hold off on submitting the report until we are able to complete a full investigation?
Featured in the May 2020 NPDB Insights

A preferred provider organization (PPO) investigated a member physician after receiving quality of care complaints from several plan participants. The physician was unaware of the investigation, but, during the investigation, he relinquished his panel membership for personal reasons. Is this reportable?
Featured in the April 2020 NPDB Insights

Is an agreement not to exercise privileges during an investigation, without actually surrendering the privileges, a resignation while under investigation that is reportable?
Featured in the March 2020 NPDB Insights

As a prerequisite for awarding laparoscopic appendectomy clinical privileges, a hospital's standard operating procedures require physicians to perform five procedures within 30 days under the supervision of a proctor. In one situation, a physician successfully completed four procedures, but no additional patients required a laparoscopic appendectomy within the 30-day time period. Consistent with the standard operating procedures, the hospital extended the time period for completing the remaining laparoscopic appendectomy. Should this be reported?
Featured in the February 2020 NPDB Insights

After conducting a professional review of a surgeon's competence, a hospital assigned a surgical proctor for 60 days. The surgeon could not perform surgery without being granted approval by the surgical proctor. Is the hospital required to report this action to the NPDB?
Featured in the January 2020 NPDB Insights

A surgeon is summarily suspended by the Chief of Staff for an outburst in the OR. An emergency meeting of the Medical Executive Committee (MEC) is convened to address the suspension. On the advice of counsel, the MEC postpones the meeting until all of the individuals involved in the incident can be present for questioning. The MEC knows that this process will take longer than 30 days on the outset. Should they wait until the final outcome before they submit a report?
Featured in the December 2019 NPDB Insights

A hospital's chief of surgery summarily suspended a physician's privileges for outbursts of anger and throwing charts and instruments in an operating room. Should this action be reported?
Featured in the November 2019 NPDB Insights

A health care practitioner pleaded nolo contendere to fraud related to a claim he made on his homeowner's insurance. Should this be reported?
Featured in the October 2019 NPDB Insights

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?
Featured in the September 2019 NPDB Insights

Dr. Jones, a physician, held clinical privileges at a hospital entitling her to perform specific procedures. The head of Dr. Jones' medical department pointed out to her that she was no longer performing some of the procedures, and the department head suggested that she voluntarily relinquish those privileges. Dr. Jones agreed. Should this voluntary relinquishment of privileges be reported?
Featured in the August 2019 NPDB Insights

A physician was indefinitely excluded from a state Medicaid program because her medical license was suspended in another state. Should this exclusion be reported?
Featured in the July 2019 NPDB Insights

If a physician's initial application for clinical privileges is denied or the privileges granted are more limited than those requested, must this be reported to the NPDB?
Featured in the June 2019 NPDB Insights

A physician applied for clinical privileges at a hospital to perform cardiac procedures. The hospital requires that such applications be granted only if the applying physician has performed 50 cardiac procedures in the previous year. The applying physician has performed only 40 such procedures. The hospital denies the application based solely on the physician not having met its 50-procedure requirement. Should this denial be reported?
Featured in the May 2019 NPDB Insights

A hospital suspended a physician's clinical privileges for 45 days for failing to complete medical records. Should this action be reported to the NPDB?
Featured in the April 2019 NPDB Insights

If a hospital began an investigation of a physician, for issues related to professional competence, 4 weeks prior to the expiration of the physician's clinical privileges and the physician failed to renew the clinical privileges while the investigation was ongoing, should it be reported to the NPDB?
Featured in the March 2019 NPDB Insights

Is a report required when clinical privileges lapse at the end of a 2-year appointment because there has been a recommendation by the Medical Executive Committee that the physician not be reappointed, but the physician's current 2-year appointment ends before a hearing can be held and final action taken by the hospital's governing body?
Featured in the February 2019 NPDB Insights

A health plan won a civil judgment against a clinical laboratory for submitting false claims. Two other health plans were party to the suit and received larger awards. Should all three health plans submit NPDB reports?
Featured in the January 2019 NPDB Insights

Is a leave of absence while under investigation considered to be a resignation of privileges that is reportable?
Featured in the December 2018 NPDB Insights

When a physician surrenders medical staff privileges due to personal reasons, infirmity, or retirement, and such surrender did not occur in order to avoid an investigation nor during an investigation, should it be reported?
Featured in the November 2018 NPDB Insights

A skilled nursing facility's contract to participate in a Federal health care program (e.g., Medicare provider agreement) is formally terminated for cause. Should this action be reported?
Featured in the October 2018 NPDB Insights

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?
Featured in the September 2018 NPDB Insights

A defendant health care practitioner settled a medical malpractice claim in exchange for being dismissed from a lawsuit. All parties involved in the lawsuit agreed to the condition. Should the resulting payment be reported to the NPDB?
Featured in the August 2018 NPDB Insights

A hospital automatically revoked a physician's clinical privileges when the physician lost her license. Should this action be reported?
Featured in the July 2018 NPDB Insights

Are medical malpractice payers required to report payments made for the benefit of a deceased practitioner?
Featured in the June 2018 NPDB Insights

If a state board denies the application of a practitioner who did not have the required number of practicum hours, should the action be reported?
Featured in the May 2018 NPDB Insights

A physician is being investigated by a hospital for issues related to professional competence and resigns her clinical privileges. At the time of her resignation, she states that she plans to move to a different state. Should the resignation be reported to the NPDB?
Featured in the April 2018 NPDB Insights

After receiving multiple "quality of care" complaints about a physician, a hospital initiated an investigation. During the investigation, the physician resigned her clinical privileges at the hospital. Since there was no professional review action taken, should a report be submitted to the NPDB?
Featured in the March 2018 NPDB Insights

Do medical malpractice payers have to report payments made for the benefit of a deceased practitioner?
Featured in the February 2018 NPDB Insights

A hospital initiated an investigation related to the professional conduct of a physician who held time-limited, nonrenewable, temporary privileges at the hospital. During the investigation, the physician's temporary privileges expired and the hospital took no further action. Should this be reported?
Featured in the January 2018 NPDB Insights

A hospital repeatedly reminded a physician to update his medical records in a timely manner. After there was no change in the physician's behavior, the hospital initiated an investigation, which revealed that the physician had more than 300 incomplete medical records. As a result, the hospital took a professional review action to suspend the physician's clinical privileges for 60 days, citing professional misconduct. Because there was no actual patient harm, should this be reported to the NPDB?
Featured in the December 2017 NPDB Insights

If an "impaired practitioner" takes a leave of absence and enters a rehabilitation program, must it be reported?
Featured in the November 2017 NPDB Insights

A hospital summarily suspended a physician's clinical privileges to allow sufficient time for allegations of gross negligence to be fully investigated. The day after the summary suspension was imposed, the physician requested an educational leave of absence. If the hospital grants the leave of absence, must the summary suspension be reported to the NPDB?
Featured in the October 2017 NPDB Insights

A hospital suspended a physician's clinical privileges for 45 days for failing to complete medical records. Should this action be reported to the NPDB?
Featured in the September 2017 NPDB Insights

Must a hospital or other health care entity report adverse actions concerning the clinical privileges of medical and dental residents and interns?
Featured in the August 2017 NPDB Insights

A health care entity (an HMO) terminated a physician's contract for causes relating to poor patient care, which in turn resulted in the loss of the practitioner's network participation. Should this be reported to the NPDB using one or two reports?
Featured in the July 2017 NPDB Insights

A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. The hospital took a professional review action to deny his renewal application, which the MEC considered to be related to the practitioner's professional conduct, even though there was no actual patient harm. Should this be reported to the NPDB?
Featured in the June 2017 NPDB Insights

A preferred provider organization (PPO) investigated a member physician after receiving quality of care complaints from several plan participants. The physician was unaware of the investigation, but during the investigation, he relinquished his panel membership for personal reasons. Is this reportable?
Featured in the May 2017 NPDB Insights

A hospital filed a report with the NPDB announcing the revocation of a practitioner's clinical privileges. The reporting hospital had established a system of professional review under its bylaws, and it also had an employment termination procedure. In this case, the hospital used the employment termination procedure, not the professional review process. The practitioner's privileges were revoked by the employment termination process, but no action was taken through the professional review process. The practitioner was not given a choice of which process (system of professional review or employment termination procedure) the hospital would use. Should the hospital have filed the report with the NPDB?
Featured in the April 2017 NPDB Insights

How should a payment be reported to the NPDB if a total amount has not been determined and the payer is making an initial partial payment?
Featured in the March 2017 NPDB Insights

Should a medical malpractice payment made exclusively for the benefit of a clinic, hospital, or other health care entity be reported?
Featured in the January 2017 NPDB Insights

A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. The hospital took a professional review action to deny his renewal application, which the medical executive committee considered to be related to the practitioner's professional conduct, even though there was no actual patient harm. Should this be reported to the NPDB?
December 2016 NPDB Insights

If a state board that regulates dietitians issues a cease and desist order against a person who is not a registered dietitian but who is practicing as one, is the issuance of the cease and desist order reportable to the NPDB?
November 2016 NPDB Insights

If a physician's initial application for clinical privileges is denied or the privileges granted are more limited than those requested, must this be reported to the NPDB?
October 2016 NPDB Insights

A physician applied to a hospital for clinical privileges to perform cardiac procedures. The hospital requires that such applications be granted only if the applying physician has performed 50 cardiac procedures in the previous year. The applying physician has performed only 40 such procedures. The hospital denies the application based solely on the physician not having met its 50-procedure requirement. Should this denial be reported to the NPDB?
September 2016 NPDB Insights

A hospital's chief of surgery summarily suspended a physician's privileges for outbursts of anger and throwing charts and instruments in an operating room. Should this action be reported to the NPDB?
August 2016 NPDB Insights

A supervisory practitioner is named in an action based on the services of a subordinate practitioner, and payments are made for the benefit of the supervisor and the subordinate. How should the payments be reported to the NPDB?
July 2016 NPDB Insights

A practitioner is meeting with the state's licensing or certification authority to discuss options for entering into an impaired practitioner program. The practitioner receives a recommendation to enter into the program. Should the licensing or certification authority report the practitioner's entering into the program to the NPDB?
June 2016 NPDB Insights

A court rules to settle a medical malpractice claim for expenses only. The defendant is released from the claim and the malpractice payer settles with the plaintiff's attorney for the amount of fees and expenses incurred by the plaintiff. Is this type of payment reportable to the NPDB?
May 2016 NPDB Insights

A surgeon is summarily suspended by the Chief of Staff for an outburst in the OR. An emergency meeting of the Medical Executive Committee (MEC) is convened to address the suspension. On advice of counsel, the MEC postpones the meeting until all of the individuals involved in the incident can be present for questioning. The MEC knows that this process will take longer than 30 days on the outset. Should they wait until the final outcome before they submit a report to the NPDB?
April 2016 NPDB Insights

A patient complains to her practitioner about an adverse reaction from an injection she received, and the practitioner offers the patient a refund for the office and injection fees. Is this refund reportable to the NPDB?
March 2016 NPDB Insights

Withdrawal of an Initial Application for Medical Staff Appointment
January 2016 NPDB Insights

A practitioner withdrew their initial application for a license with a state board. Is it reportable?
No. Withdrawals of initial applications are not reportable for any reason. However, if the practitioner will not be allowed to, or loses the right to reapply, the state board must report the loss of the ability to reapply. Additionally, withdrawal of a renewal application for licensure, or failure to renew, while the state board is investigating the practitioner, is reportable. October 2015 NPDB Insights