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Back To Vidyya Malpractice Payment Reporting Requirements On Hold


Comments & Concerns Make Government Officials Issue a Second Notice Of Proposed Rulemaking


The 17-Apri-2000 Federal Register contained good news for physicians concerned about the proposed new medical malpractice payment reporting requirements to the National Practitioner Databank (NPDB).

The rules were first proposed in December of 1998. The Health Resources and Services Administration and the Department of Health and Human Services believed that some physicians had been shielded by organizations that have protected them from the responsibility of reporting to the NPDB and that current requirements might be unduly harsh for residents.

Hundreds of health care professionals wrote to comment on the propsed rules. The comments voiced a high level of concern on the potential impact the new rules would have on the profession. As a result the HRSA decided to gather additional data and to conduct further analyses before proceeding. A new Notice of Proposed Rulemaking will be ready for public comment soon, with a goal for a revised proposal by the end of 2000. As a result, final regulations are not expected to be implemented until 2001.

Currently, when filing a medical malpractice payment, a physician or organization is required to follow the rules below and divulge the following:

From:
Code of Federal Regulations
Title 45, Volume 1, Parts 1 to 199
Revised as of October 1, 1999
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR60.7]


Sec. 60.7 Reporting medical malpractice payments.

  • (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 Federal Register and after an opportunity for public comment.
  • (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.

    After the information is reported to the NPDB it can be accessed by any qualified individual with a credit card and $10.00. If you're not familiar with the National Practitioner's Databank, you can visit its Web site at www.npdb.com.



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Editor: Susan K. Boyer, RN
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