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Your Responsibilities for Reporting State Health Care-Related Prosecutions and Civil Judgments to the NPDB

Federal, state, and local prosecutors must report criminal convictions against health care practitioners, providers, or suppliers related to the delivery of health care items or services, regardless of whether the conviction is the subject of a pending appeal.

Federal and state attorneys and health plans must report civil judgments related to the delivery of a health care item or service against health care practitioners, providers, or suppliers, regardless of whether the civil judgment is the subject of a pending appeal. NPDB regulations define civil judgment as "a court-ordered action rendered in a federal or state court proceeding, other than a criminal proceeding.

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If you fall into either of the below groups, you may be responsible for submitting a report to the NPDB:

  • A federal or state prosecutor involved in a case in which a healthcare practitioner, provider, or supplier was convicted
  • A federal or state attorney or a health plan that was party to a civil judgment against a health care practitioner, provider or supplier

 

A criminal conviction against a health care practitioner, provider, or supplier is reportable to the NPDB when it is related to the delivery of a health care item or service and includes:

  • A conviction entered against the individual or entity in a federal, state, or local court, regardless of whether there is an appeal pending or whether the conviction or other record relating to criminal conduct has been expunged.
  • A finding of guilt against the individual or entity in a federal, state, or local court.
  • A plea of guilty or nolo contendere by the individual or entity accepted by a federal, state, or local court.
  • A case when the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where judgment or conviction has been withheld.
  • Health care-related injunctions also must be reported.

A civil judgment against a health care practitioner, provider, or supplier is reportable to the NPDB regardless of whether the judgment is on appeal, when it is related to the delivery of a health care item or service.

Reporting for Multi-Party Suits

  • A government agency in a multi-party suit must report the entire action, including all amounts awarded to all claimants, both public and private.
  • If a government agency is not a party, but there are multiple health plan claimants, the health plan with the largest award must report the total action for all parties.

 

The report must be submitted to the NPDB within 30 calendar days of the date of the conviction, regardless of whether the conviction is the subject of a pending appeal.

 

The U.S. Department of Health and Human Services (HHS) has undertaken compliance efforts through the Health Resources and Services Administration (HRSA) to improve the completeness and accuracy of data reported to the NPDB. In addition, the Secretary of HHS exercises regulatory authority (45 CFR part 60) to publish a report listing government agencies that have failed to meet their NPDB reporting requirements.

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