Is It Reportable?
A patient made a written demand for a refund for services and, in response, the practitioner made the payment out of her personal funds. Should the payment be reported to the NPDB?
Featured in the November 2024 NPDB Insights
View AnswerIs It Reportable? Archive
A state licensing board submitted a report to the NPDB 6 months ago, after the board placed a practitioner's license on probation. Three months ago, the board reinstated the license. The report in the NPDB still indicates that the license is on probation. Should the board update the information in the NPDB now that the licensure action's status has changed?
Featured in the October 2024 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 September 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 to the NPDB?
Featured in the June 2024 NPDB Insights
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 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
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 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
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
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
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
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 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
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 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
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 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
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
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 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
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