The main reporting entities that affect most health care professionals are insurance carriers or anyone who makes an indemnity payment on behalf of the health care provider, hospitals or health care employers and state licensing boards.
With respect to insurance indemnity payments, the general rule is you may report any payment made on your behalf to release you from a lawsuit. In the past, physicians would be released and the hospital or corporations would assume liability to avoid reporting. This practice is no longer allowed. The payor must report the payment to the NPDB regardless of the amount.
As for discipline, when a health care practitioner faces disciplinary action by their state licensing board, summary/emergency suspension of their license, or action taken by a credentialing body, a report must be sent to the NPDB within 15 days.
Therefore, it is important to understand that when a physician, dentist, nurse, physician assistant or other health care practitioner is facing a licensing or credentialing issue, they must contact a knowledgeable health law attorney. A health care layer will work with you to limit or reduce the discipline, which results in no reporting or a more favorable report to the NPDB.