Health Care Organizations
Reporting
What You Must Report to the Data Bank
The Data Bank collects information on and maintains reports on the following:
- Medical malpractice payments
- Adverse licensure and certification actions
- Adverse clinical privilege actions
- Adverse professional society membership actions
- Health care-related criminal convictions and civil judgments and other adjudicated actions
- Medicare/Medicaid exclusions
- Other adjudicated actions against practitioners, providers, and suppliers
- Any negative action or finding against a health care practitioner or entity
The reports collected apply to physicians, dentists, health care practitioners, health care entities, other health care providers and suppliers based on the laws that govern the National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Data Bank (HIPDB).
Reporting to the right Data Bank is easy. Based on your Data Bank registration a report is automatically placed in one or both Data Banks. Your biggest challenge in reporting to the Data Bank is understanding what actions are reportable.
Get More Help
Because decisions on what to report are based on statutory requirements, consult the NPDB Regulations, NPDB Guidebook (Chapter E, 'Reports') (PDF - 796 KB), the HIPDB regulations, HIPDB Guidebook (Chapter E, 'Reports') (PDF - 318 KB), Section 1921 reporting requirements and FAQs for detailed descriptions and examples of reportable actions.
The Data Bank Online Training provides additional guidance designed especially for reporting organizations.
Reportable Actions
Tables 1 and 2 provide a quick orientation and overview on what to report. Consult the Guidebooks for more detailed information.
| Reporting Organization | Reportable Action | Subject of Report | ||
|---|---|---|---|---|
| Physicians and Dentists | Other Health Care Practitioners | Other Health Care Entities | ||
| Medical Malpractice Payers | Payment resulting from written claim or judgment (Reports must be submitted to the NPDB and appropriate State licensing board within 30 days of a payment.) |
Must report | Must report | No reporting requirement |
| State Licensing Boards | Licensure disciplinary action based on reasons related to professional competence or conduct Any other negative action or finding (Section 1921) (Reports must be submitted to the NPDB within 30 days of the action.) |
Must report | Must report under Section 1921 | Must report under Section 1921 |
| Hospitals and Other Health Care Entities | Professional review action, 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, investigation (Reports must be submitted to the NPDB and appropriate State licensing board within 30 days of the action.) |
Must report | May report | No reporting requirement |
| Professional Societies with formal peer review | Professional review action, 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.) |
Must report | May report | No reporting requirement |
| Peer review and private accreditation organizations | Any final negative action or finding | Must report under Section 1921 | Must report under Section 1921 | Must report under Section 1921 |
| HHS Office of Inspector General | Exclusions from Medicaid/Medicare and other Federal programs. (Exclusions are reported to NPDB monthly.) |
Must report | Must report | No reporting requirement |
| Reporting Organization | Reportable Action | Subject of Report | |
|---|---|---|---|
| All Licensed or Certified Health Care Practitioners | Health Care Providers and Suppliers | ||
| Federal, State, and Local Prosecutors, Law Enforcement and Investigative Agencies | Criminal convictions, civil judgments (excluding those resulting from medical malpractice), injunctions, and nolo contendere/no contest pleas related to delivery of a health care item or service *See below |
Must Report | Must Report |
| Federal and State Licensing or Certification Agencies | Final adverse actions related to the delivery of a health care item or service *See below |
Must report | Must report |
| Federal and State Government Agencies | Exclusions from participating in Federal or State health care programs *See below |
Must report | Must report |
| Federal and State Government Agencies and Health Plans | Other adjudicated actions or decisions related to the delivery of a health care item or service *See below |
Must report | Must report |
*Reports must be submitted to the HIPDB by whichever is the later of the following: 1) Within 30 days from the date the final adverse action was taken; 2) Within 30 days of the date when the reporting organization became aware of the final adverse action; 3) By the close of the organization's next monthly reporting cycle.
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 $11,000 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.
To the HIPDB:
- Any health plan that fails to report information on an adverse action required to be reported to the HIPDB shall be subject to a civil money penalty of up to $25,000 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 appropriate Guidebook for additional details in the chapters on reports.
