NPDB Insights - June 2021

Is It Reportable?

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.

Imposition of a quality improvement plan raises two issues with respect to reportability. First, a quality improvement plan may restrict a practitioner's clinical privileges. If so, and if the restriction is the result of a professional review action, concerns the practitioner's professional competence or conduct, and is in place longer than 30 days, the plan may be reportable.

Second, if the quality improvement plan does not meet these requirements, it nonetheless may be considered an investigation so long as it meets the other requirements for an investigation (for more information, see the Investigations section of the NPDB Guidebook.) The reporting entity needs to determine whether the quality improvement plan is focused on one practitioner for competency concerns and whether such plans typically lead to a professional review action. When making this determination, the entity should consider the language of the plan: Does it describe future disciplinary measures that may follow if the elements of the plan are not met? The entity also may consult its bylaws and policies, as well as standard practices, to decide whether the plan is the type of inquiry that leads to a professional review action. If the quality improvement plan meets the requirements of an investigation, then a resignation while under the plan would be reportable.

Reporting Updates for State Licensing Boards and Certification Agencies

The NPDB is streamlining the selection of the subject's profession when you submit a report. Currently, you must select the subject's profession from a list of all NPDB professions. As of June 25, 2021, this list will only include professions regulated by your agency. Administrators can review and update this list at any time by signing in to their account, selecting Administrator Options, and then selecting Regulated Professions. Administrators can also easily add descriptions for professions, such as "Intern" or "Certified."

Only administrators can add or delete professions from this list. If a user needs to submit a report on a subject whose profession is not on their agency's list of regulated professions, they will be instructed to save the report as a draft and contact their administrator.

If your agency uses a third-party credentialing system or other software to directly connect to the NPDB, please ensure that your list of regulated professions is updated to prevent report submissions from being rejected.

In addition, the NPDB is updating the description in state licensure reports for an action that limits a practitioner's authorization to prescribe, dispense, or administer medication or sedation (Code 1179). When selecting that action in a report, you must add a description of the action taken. The basis codes related to this action have been updated. Refer to the Code List for the appropriate updates.

For more information about reporting updates for state licensing boards and certification agencies, visit our State Licensing and Certification Agencies page.

Step-by-Step: Reporting Criminal Convictions

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. For NPDB purposes, a criminal conviction includes:

• A judgment or conviction that has been entered against an individual or entity in a federal, state, or local court, regardless of whether an appeal is pending or other record relating to criminal conduct has been expunged
• When an individual or entity has entered into participation in a first offender, deferred adjudication, or other agreement or program where conviction has been withheld
• A plea of guilty or nolo contendere by an individual or entity that has been accepted by a federal, state, or local court
• A finding of guilt against an individual or entity that is made in a federal, state, or local court

How to Submit a Health Care-Related Criminal Conviction

1. Sign in to the NPDB and select Report on the Select an Option page.
2. On the Identify the Subject page, select whether the subject is an Organization or an Individual, then enter the subject's name.
   Exit

   Identify the Subject

   
3. Select that you are reporting a Criminal Conviction on the following page.
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   Select the Action

   
4. Complete the Subject Information page. Be sure to fill out as much information on the subject as possible to help querying organizations find your report.
   1. If the subject is a person, enter his or her personal information, such as name and birth date. If the subject is an organization, enter the organization name, type, and description.
   2. For individuals, enter the subject's home and work address and organization name. For organizations, enter the organization's address and principal owners.
   3. Enter the subject's known identification numbers, which can include a Social Security Number, IRS Taxpayer ID Number, Employer ID Number, National Provider Number, or Drug Enforcement Administration Number.
   4. Enter the name or names of the health care entity or entities with which the subject is affiliated. If the subject is an organization, also enter the organization's state licensure information.
5. Complete the Action Information section.
   1. Enter the adverse action information, such as the jurisdiction, the venue (court name) and location of the venue, the docket or court file number, the prosecuting agency and corresponding case number, the name of the investigating agency and corresponding case number, and the statute information.
   2. Enter the acts or omissions, describe them, and the reason the action was taken.
   3. Enter the sentence/judgment information, such as the date of the sentence or judgment, whether the action is on appeal and the date of said appeal, the amount of restitution and other amount ordered, the sentence or judgment type and length, and any other court orders.
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   Action Information

   
6. Review the information you provided to ensure it is correct, then complete the Certification Section.
7. Scan or print a copy of the report on the Report Submission Complete page for your records.

As noted in the NPDB Guidebook, entities are not excused from reporting simply because they missed a reporting deadline or failed to file a report when required. Reports must still be submitted as soon as possible after a deadline is missed or the error is discovered.

For more comprehensive instructions and requirements for health care-related criminal conviction reports, see the NPDB regulations and the NPDB Guidebook.

Looking for more information on how to submit other types of reports? Check out our Introduction to Reporting, Reporting Clinical Privileges Actions, Reporting State Licensure Actions, Reporting Medical Malpractice Payments, and Reporting Civil Judgments articles. Keep an eye on NPDB Insights for upcoming articles on how to report other adjudicated actions or decisions.

Dear NPDB

How Do I View an Old Self-Query Response?

By ordering a Self-Query, health care professionals and organizations can find out if there is a report on them in the NPDB. Self-Query responses can be used for any purpose, including employment, certification, licensure, or personal history. However, submitting a Self-Query response to a potential employer or licensing agency does not relieve the entity of any obligation it has to independently query the NPDB.

Each Self-Query response is only valid and available for 45 days from the processing date. To access your Self-Query response during the 45 day period, use the order ID and password on your response to log in to the Self-Query system. After 45 days you will need to submit a new Self-Query order if you want a new response.

For instructions on how to submit a Self-Query, visit our Self-Query Basics page or check out our Get Your NPDB Self-Query infographic.