45 C.F.R. Subpart B—Reporting of Information
Title 45 - Public Welfare
Information must be reported to the Data Bank or to a Board of Medical Examiners as required under §§60.7, 60.8, and 60.9 in such form and manner as the Secretary may prescribe. Information required under §§60.7, 60.8, and 60.9 must be submitted to the Data Bank within 30 days following the action to be reported, beginning with actions occurring on or after September 1, 1990, as follows: (a) Malpractice Payments (§60.7). Persons or entities must submit information to the Data Bank within 30 days from the date that a payment, as described in §60.7, is made. If required under §60.7, this information must be submitted simultaneously to the appropriate State licensing board. (b) Licensure Actions (§60.8). The Board must submit information within 30 days from the date the licensure action was taken. (c) Adverse Actions (§60.9). A health care entity must report an adverse action to the Board within 15 days from the date the adverse action was taken. The Board must submit the information received from a health care entity within 15 days from the date on which it received this information. If required under §60.9, this information must be submitted by the Board simultaneously to the appropriate State licensing board in the State in which the health care entity is located, if the Board is not such licensing Board. [54 FR 42730, Oct. 17, 1989, as amended at 55 FR 50003, Dec. 4, 1990] (a) Persons and entities are responsible for the accuracy of information which they report to the Data Bank. If errors or omissions are found after information has been reported, the person or entity which reported it must send an addition or correction to the Data Bank or, in the case of reports made under §60.9, to the Board of Medical Examiners, as soon as possible. (b) An individual or entity which reports information on licensure or clinical privileges under §§60.8 or 60.9 must also report any revision of the action originally reported. Revisions include reversal of a professional review action or reinstatement of a license. Revisions are subject to the same time constraints and procedures of §§60.5, 60.8, and 60.9, as applicable to the original action which was reported. [54 FR 42730, Oct. 17, 1989, as amended at 55 FR 50004, Dec. 4, 1990] (a) Who must report. Each entity, including an insurance company, which makes a payment under an insurance policy, self-insurance, or otherwise, for the benefit of a physician, dentist or other health care practitioner in settlement of or in satisfaction in whole or in part of a claim or a judgment against such physician, dentist, or other health care practitioner for medical malpractice, must report information as set forth in paragraph (b) to the Data Bank and to the appropriate State licensing board(s) in the State in which the act or omission upon which the medical malpractice claim was based. For purposes of this section, the waiver of an outstanding debt is not construed as a “payment” and is not required to be reported. (b) What information must be reported. Entities described in paragraph (a) must report the following information: (1) With respect to the physician, dentist or other health care practitioner for whose benefit the payment is made— (i) Name, (ii) Work address, (iii) Home address, if known, (iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act of 1974, (v) Date of birth, (vi) Name of each professional school attended and year of graduation, (vii) For each professional license: the license number, the field of licensure, and the name of the State or Territory in which the license is held, (viii) Drug Enforcement Administration registration number, if known, (ix) Name of each hospital with which he or she is affiliated, if known; (2) With respect to the reporting entity— (i) Name and address of the entity making the payment, (ii) Name, title, and telephone number of the responsible official submitting the report on behalf of the entity, and (iii) Relationship of the reporting entity of the physician, dentists, or other health care practitioner for whose benefit the payment is made; (3) With respect to the judgment or settlement resulting in the payment— (i) Where an action or claim has been filed with an adjudicative body, identification of the adjudicative body and the case number, (ii) Date or dates on which the act(s) or omission(s) which gave rise to the action or claim occurred, (iii) Date of judgment or settlement, (iv) Amount paid, date of payment, and whether payment is for a judgment or a settlement, (v) Description and amount of judgment or settlement and any conditions attached thereto, including terms of payment, (vi) A description of the acts or omissions and injuries or illnesses upon which the action or claim was based, (vii) Classification of the acts or omissions in accordance with a reporting code adopted by the Secretary, and (viii) Other information as required by the Secretary from time to time after publication in the (c) Sanctions. Any entity that fails to report information on a payment required to be reported under this section is subject to a civil money penalty of up to $10,000 for each such payment involved. This penalty will be imposed pursuant to procedures at 42 CFR part 1003. (d) Interpretation of information. A payment in settlement of a medical malpractice action or claim shall not be construed as creating a presumption that medical malpractice has occurred. [54 FR 42730, Oct. 17, 1989, as amended at 59 FR 61555, Dec. 1, 1994] (a) What actions must be reported. Each Board of Medical Examiners must report to the Data Bank any action based on reasons relating to a physician's or dentist's professional competence or professional conduct– (1) Which revokes or suspends (or otherwise restricts) a physician's or dentist's license, (2) Which censures, reprimands, or places on probation a physician or dentist, or (3) Under which a physician's or dentist's license is surrendered. (b) Information that must be reported. The Board must report the following information for each action: (1) The physician's or dentist's name, (2) The physician's or dentist's work address, (3) The physician's or dentist's home address, if known, (4) The physician's or dentist's Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act of 1974, (5) The physician's or dentist's date of birth, (6) Name of each professional school attended by the physician or dentist and year of graduation, (7) For each professional license, the physician's or dentist's license number, the field of licensure and the name of the State or Territory in which the license is held, (8) The physician's or dentist's Drug Enforcement Administration registration number, if known, (9) A description of the acts or omissions or other reasons for the action taken, (10) A description of the Board action, the date the action was taken, and its effective date, (11) Classification of the action in accordance with a reporting code adopted by the Secretary, and (12) Other information as required by the Secretary from time to time after publication in the (c) Sanctions. If, after notice of noncompliance and providing opportunity to correct noncompliance, the Secretary determines that a Board has failed to submit a report as required by this section, the Secretary will designate another qualified entity for the reporting of information under §60.9.
Title 45: Public Welfare
PART 60—NATIONAL PRACTITIONER DATA BANK FOR ADVERSE INFORMATION ON PHYSICIANS AND OTHER HEALTH CARE PRACTITIONERS
Subpart B—Reporting of Information
§ 60.4 How information must be reported.
§ 60.5 When information must be reported.
§ 60.6 Reporting errors, omissions, and revisions.
§ 60.7 Reporting medical malpractice payments.
§ 60.8 Reporting licensure actions taken by Boards of Medical Examiners.
§ 60.9 Reporting adverse actions on clinical privileges.
(a) Reporting to the Board of Medical Examiners—(1) Actions that must be reported and to whom the report must be made. Each health care entity must report to the Board of Medical Examiners in the State in which the health care entity is located the following actions:
(i) Any professional review action that adversely affects the clinical privileges of a physician or dentist for a period longer than 30 days;
(ii) Acceptance of the surrender of clinical privileges or any restriction of such privileges by a physician or dentist—
(A) While the physician or dentist is under investigation by the health care entity relating to possible incompetence or improper professional conduct, or
(B) In return for not conducting such an investigation or proceeding; or
(iii) In the case of a health care entity which is a professional society, when it takes a professional review action concerning a physician or dentist.
(2) Voluntary reporting on other health care practitioners. A health care entity may report to the Board of Medical Examiners information as described in paragraph (a)(3) of this section concerning actions described in paragraph (a)(1) in this section with respect to other health care practitioners.
(3) What information must be reported. The health care entity must report the following information concerning actions described in paragraph (a)(1) of this section with respect to the physician or dentist:
(i) Name,
(ii) Work address,
(iii) Home address, if known,
(iv) Social Security number, if known, and if obtained in accordance with section 7 of the Privacy Act of 1974,
(v) Date of birth,
(vi) Name of each professional school attended and year of graduation,
(vii) For each professional license: the license number, the field of licensure, and the name of the State or Territory in which the license is held,
(viii) Drug Enforcement Administration registration number, if known,
(ix) A description of the acts or omissions or other reasons for privilege loss, or, if known, for surrender,
(x) Action taken, date the action was taken, and effective date of the action, and
(xi) Other information as required by the Secretary from time to time after publication in the
(b) Reporting by the Board of Medical Examiners to the National Practitioner Data Bank. Each Board must report, in accordance with §§60.4 and 60.5, the information reported to it by a health care entity and any known instances of a health care entity's failure to report information as required under paragraph (a)(1) of this section. In addition, each Board must simultaneously report this information to the appropriate State licensing board in the State in which the health care entity is located, if the Board is not such licensing board.
(c) Sanctions—(1) Health care entities. If the Secretary has reason to believe that a health care entity has substantially failed to report information in accordance with §60.9, the Secretary will conduct an investigation. If the investigation shows that the health care entity has not complied with §60.9, the Secretary will provide the entity with a written notice describing the noncompliance, giving the health care entity an opportunity to correct the noncompliance, and stating that the entity may request, within 30 days after receipt of such notice, a hearing with respect to the noncompliance. The request for a hearing must contain a statement of the material factual issues in dispute to demonstrate that there is cause for a hearing. These issues must be both substantive and relevant. The hearing will be held in the Washington, DC, metropolitan area. The Secretary will deny a hearing if:
(i) The request for a hearing is untimely,
(ii) The health care entity does not provide a statement of material factual issues in dispute, or
(iii) The statement of factual issues in dispute is frivolous or inconsequential.
In the event that the Secretary denies a hearing, the Secretary will send a written denial to the health care entity setting forth the reasons for denial. If a hearing is denied, or if as a result of the hearing the entity is found to be in noncompliance, the Secretary will publish the name of the health care entity in the
(2) Board of Medical Examiners. If, after notice of noncompliance and providing opportunity to correct noncompliance, the Secretary determines that a Board has failed to report information in accordance with paragraph (b) of this section, the Secretary will designate another qualified entity for the reporting of this information.
(Approved by the Office of Management and Budget under control number 0915–0126)[54 FR 42730, Oct. 17, 1989, as amended at 59 FR 61555, Dec. 1, 1994]
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