Should they wait until the final outcome before they submit a report? The practitioner receives a recommendation to enter into the program. 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? Italiano 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? 
The surgeon could not perform surgery without being granted approval by the surgical proctor. At the time of her resignation, she states that she plans to move to a different state. , Ting Ving Should this action be reported to the NPDB? The nurse was afforded due process. All parties involved in the lawsuit agreed to the condition. 
The reporting hospital had established a system of professional review under its bylaws, and it also had an employment termination procedure. The hospital denies the application based solely on the physician not having met its 50-procedure requirement. Should this action be reported to the NPDB? Should this denial be reported? 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. 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? In one situation, a physician successfully completed four procedures, but no additional patients required a laparoscopic appendectomy within the 30-day time period. At the time of her resignation she states that she plans to move to a different state. Featured in the January 2018 NPDB Insights, A hospital repeatedly reminded a physician to update his medical records in a timely manner. After conducting a professional review of a surgeon's competence, a hospital assigned a surgical proctor for 60 days. A physician is being investigated by a hospital for issues related to professional competence and resigns her clinical privileges. Featured in the February 2022 NPDB Insights, If a professional society denies membership to a physician, should it be reported to the NPDB? Should the resulting payment be reported to the NPDB? For organizations, notification preferences are managed through your individual user account. Should this action be reported to the NPDB? Withdrawals of initial applications are not reportable for any reason. If you are a member of the media, please contact our press office. 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. Should the action be reported to the NPDB? 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. Note: The NPDB does not share email addresses with other parties. The day after the summary suspension was imposed, the physician requested an educational leave of absence. Is a resignation while subject to a "quality improvement plan" a resignation while under investigation? The practitioner's privileges were revoked by the employment termination process, but no action was taken through the professional review process. 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. For language assistance with the NPDB, contact the Customer Service Center. Italiano Should the licensing or certification authority report the practitioner's entering into the program to the NPDB? The physician was unaware of the investigation, but, during the investigation, he relinquished his panel membership for personal reasons. Should the hospital have filed the report with the NPDB? Should this denial be reported to the NPDB? To improve health care quality, protect the public, and reduce health care fraud and abuse in the U.S. 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? A hospital suspended a physician's clinical privileges for 45 days for failing to complete medical records. Kreyol Ayisyen October 2016 NPDB Insights, A physician applied to a hospital for clinical privileges to perform cardiac procedures. You have successfully signed up to receive the NPDB Insights. The applying physician has performed only 40 such procedures. Is a leave of absence while under investigation considered to be a resignation of privileges that is reportable? A state licensing board issued a formal cease and desist order to an unlicensed practitioner who held herself out to be a licensed psychotherapist. 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? Should this be reported? 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? Should the resulting payment be reported to the NPDB? The hospital denies the application based solely on the physician not having met its 50-procedure requirement. Is this reportable? On advice of counsel, the MEC postpones the meeting until all of the individuals involved in the incident can be present for questioning. The practitioner was not given a choice of which process (system of professional review or employment termination procedure) the hospital would use. Should all three health plans submit NPDB reports? Is this type of payment reportable to the NPDB? The hospital denies the application based solely on the physician not having met its 50-procedure requirement. 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. Dr. Jones agreed. Espanol Is this reportable? 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. 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? June 2016 NPDB Insights, A court rules to settle a medical malpractice claim for expenses only. The hospital requires that such applications be granted only if the applying physician has performed 50 cardiac procedures in the previous year. 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. Polski 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? A hospital initiated an investigation related to the professional conduct of a physician who held time-limited, nonrenewable, temporary privileges at the hospital. The practitioner receives a recommendation to enter into the program. The physician's license lapsed prior to any proposed agreement or board decision, so must the lapse be reported to the NPDB? Is this reportable? 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? 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. Should this action be reported? Should this be reported? The day after the summary suspension was imposed, the physician requested an educational leave of absence. Deutsch, A hospital filed a report with the NPDB announcing the revocation of a practitioner's clinical privileges. , 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. Should this be reported? 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? 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. Is this reportable? 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 the resignation be reported to the NPDB? Featured in the February 2019 NPDB Insights, A health plan won a civil judgment against a clinical laboratory for submitting false claims. An emergency meeting of the Medical Executive Committee (MEC) is convened to address the suspension. 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. Two other health plans were party to the suit and received larger awards. Should this be reported? 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 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. 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. 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. 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. 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. 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. The NPDB Guidebook serves as a policy manual to inform the U.S. health care community and others about the requirements established by these statutes. In one situation, a physician successfully completed four procedures, but no additional patients required a laparoscopic appendectomy within the 30-day time period. A hospital summarily suspended a physician's clinical privileges to allow sufficient time for allegations of gross negligence to be fully investigated. 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. Get the latest updates by subscribing to NPDB Insights. U.S. Department of Health & Human Services, Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660. The NPDB assists in promoting quality health care and deterring fraud and abuse within health care delivery systems. 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 November 2019 NPDB Insights, A health care practitioner pleaded nolo contendere to fraud related to a claim he made on his homeowner's insurance. Are medical malpractice payers required to report payments made for the benefit of a deceased practitioner? Deutsch, 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. Should the licensing or certification authority report the practitioner's entering into the program to the NPDB? 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 voluntary relinquishment of privileges be reported? Two weeks later, the physician allowed his license to expire. An emergency meeting of the Medical Executive Committee (MEC) is convened to address the suspension. Featured in the December 2021 NPDB Insights, A hospital repeatedly reminded a physician to update his medical records in a timely manner. A board of medical examiners initiated an investigation related to a physician's professional conduct. Should this event be reported to the NPDB? Franais An emergency meeting of the Medical Executive Committee (MEC) is convened to address the suspension. 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? The practitioner's privileges were revoked by the employment termination process, but no action was taken through the professional review process. If the hospital grants the leave of absence, must the summary suspension be reported to the NPDB? Is the termination reportable? The MEC knows that this process will take longer than 30 days on the outset. As a result, the hospital took a professional review action to suspend the physician's clinical privileges for 60 days, citing professional misconduct. 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? During the investigation, the physician resigned her clinical privileges at the hospital. 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 September 2019 NPDB Insights, Dr. Jones, a physician, held clinical privileges at a hospital entitling her to perform specific procedures. Should this action be reported? 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. Must a hospital or other health care entity report adverse actions concerning the clinical privileges of medical and dental residents and interns? If a professional society denies membership to a physician, should it be reported to the NPDB? At the time of her resignation she states that she plans to move to a different state. U.S. Department of Health & Human Services. The practitioner was not given a choice of which process (system of professional review or employment termination procedure) the hospital would use. Featured in the July 2021 NPDB Insights, Is a resignation while subject to a "quality improvement plan" a resignation while under investigation? The physician's license lapsed prior to any proposed agreement or board decision, so must the lapse be reported to the NPDB? Is this refund reportable to the NPDB? Consistent with the standard operating procedures, the hospital extended the time period for completing the remaining laparoscopic appendectomy. During the investigation, the physician's temporary privileges expired and the hospital took no further action. 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. The physician was unaware of the investigation, but, during the investigation, he relinquished his panel membership for personal reasons. Get the latest updates by subscribing to NPDB Insights. Should this be reported? Does a medical malpractice payment have to exceed a certain dollar amount before it is reportable to the NPDB? Two weeks later, the physician allowed his license to expire. Polski To ensure your entity is able to receive NPDB email, add npdb.hrsa.gov to your Safe Sender List. A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. Is this reportable? 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. Should the resignation be reported to the NPDB? 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. English. 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. Portugues May 2016 NPDB Insights, A surgeon is summarily suspended by the Chief of Staff for an outburst in the OR. , Ting Ving On advice of counsel, the MEC postpones the meeting until all of the individuals involved in the incident can be present for questioning. 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. 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. 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. 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. Since there was no professional review action taken, should a report be submitted to the NPDB? Tagalog Espanol In this case, the hospital used the employment termination procedure, not the professional review process. A surgeon is summarily suspended by the Chief of Staff for an outburst in the OR. 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. Should the resignation be reported to the NPDB? As a result, the hospital took a professional review action to suspend the physician's clinical privileges for 60 days, citing professional misconduct. English. Should this action be reported to the NPDB? Should the resulting payment be reported to the NPDB? For organizations, notification preferences are managed through your individual user account. 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. A physician applying for renewal of his hospital clinical privileges falsified his application by omitting information about an ongoing licensure investigation. 
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 this action be reported to the NPDB? , A health care practitioner pleaded nolo contendere to fraud related to a claim he made on his homeowner's insurance. The reports are confidential, and not available to the public. Should this exclusion be reported? How should the payments be reported to the NPDB? Should this action 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. Is the termination reportable? Is this reportable? 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 a medical malpractice payment made exclusively for the benefit of a clinic, hospital, or other health care entity be reported? U.S. Department of Health & Human Services. Two other health plans were party to the suit and received larger awards. Eligible entities, as defined by NPDB statutes, report to and/or query the NPDB. Is it reportable? The MEC knows that this process will take longer than 30 days on the outset. 
A health plan won a civil judgment against a clinical laboratory for submitting false claims. Should this event be reported to the NPDB? For language assistance with the NPDB, contact the Customer Service Center. Should this voluntary relinquishment of privileges be reported? A court rules to settle a medical malpractice claim for expenses only. A physician applied for clinical privileges at a hospital to perform cardiac procedures. Do medical malpractice payers have to report payments made for the benefit of a deceased practitioner?
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