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Federal Hospitals and Federal Government Agencies

Federal government agencies include, but are not limited to, the following:

  • Federal hospitals, such as those operating under the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DOD). Federal hospitals have reporting requirements both as hospitals and as federal government agencies.
  • U.S. Department of Justice
  • U.S. Department of Health and Human Services
  • Federal law enforcement agencies, including law enforcement investigators
  • Any other federal agency that either administers or provides payment for the delivery of health care services, including, but not limited to, the DOD and VA
  • Federal agencies responsible for the licensing and certification of health care practitioners, providers, and suppliers

Querying for Federal Government Agencies

A query is a search for information in the NPDB regarding a health care practitioner or organization. Agencies administering government health care programs, including private entities administering such programs under contract; federal law enforcement officials and agencies; and federal agencies responsible for the licensing or certification of health care practitioners, providers, or suppliers, may query the NPDB:

  • When they are determining the fitness of individuals to provide health care services
  • When they are protecting the health and safety of individuals receiving health care through programs they administer
  • When they are protecting the fiscal integrity of the programs they administer

In a query response, these entities may receive the following reported actions:

  • Licensure and certification actions taken by states
  • Federal licensing and certification actions
  • Negative actions or findings by peer review organizations or private accreditation entities
  • Health care-related criminal convictions
  • Health care-related civil judgments
  • Exclusions from participating in federal or state health care programs
  • Other health care-related adjudicated actions or decisions

Reporting Requirements for Federal Government Agencies, including Federal Hospitals

Maintaining complete, accurate, timely, and reliable information in the NPDB is only possible with the involvement of health care organizations and government agencies. Your organization has a vital role in ensuring that adverse information about practitioners' competence and conduct is readily available to the health care community through the NPDB. Timely submission of reports to the NPDB helps protect patient safety. Federal government agencies must also report any revisions to previously reported actions, such as reinstatements, and whether an action is on appeal.

Exclusions, adjudicated actions, civil judgments, and criminal convictions must be reported within 30 days following the action. The following links provide detailed information about the actions federal government agencies are required to be report:

Under several memorandums of understanding or agreements with HHS, certain agencies, including most federal hospitals, must report the following:

Adjudicated Actions or Decisions

Adjudicated actions or decisions are formal or official final actions taken by a federal governmental agency, a state law or fraud enforcement agency, or a health plan. They include, but are not limited to, personnel-related actions such as suspensions without pay, reductions in pay, reductions in grade for cause, terminations, or other comparable actions.

Reportable adjudicated actions or decisions include due process mechanisms. The fact that the practitioner elects not to use the due process mechanism is immaterial, as long as such a process is available to the practitioner before the adjudicated action or decision is made final. In general, if an "adjudicated action or decision" follows an agency's established administrative procedures (which ensure that due process is available to the subject of the final adverse action), it would qualify as a reportable action under this definition. This definition specifically excludes clinical privileging actions taken by federal government agencies, as described under appropriate Memorandums of Understanding.

Refer to the NPDB Guidebook: Chapter E, Reports, Reporting Other Adjudicated Actions or Decisions and the Q&As for more information.

Exclusions from Participation In Federal Health Care Programs

Federal government agencies must report "exclusions" to the NPDB. An exclusion is a temporary or permanent debarment of an individual or entity from participation in any federal health-related program, such that items or services furnished by the individual or entity will not be reimbursed under any federal health-related program.

Refer to the NPDB Guidebook: Chapter E, Reports, Reporting Exclusions from Participation In Federal or State Health Care Programs and the Q&As for more information.

Federal Health Care-Related Civil Judgments and Criminal Convictions

Federal government agencies must report health care-related civil judgments and settlements, which consist of a court-ordered action rendered in a court proceeding, other than a criminal proceeding. Settlements in which no findings of liability have been made are excluded from being reported.

Federal government agencies must also report health care-related criminal convictions they prosecute, which are findings of guilt against a practitioner, provider, or supplier that is made in federal court. Pleas of guilt and nolo contendere by individuals or entities are also reportable.


Registration

All federal government agencies that either administer health care services or provide payment for their delivery should be registered with the NPDB. Even if your agency is also a hospital that uses an agent or Credentials Verification Organization (CVO) to query, it must first register. After registering, you may designate the agent or CVO to act on behalf of your agency. Each individual using the NPDB must have a unique user ID assigned by his or her Data Bank administrator. Users cannot share user IDs or passwords.

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