Action Reportable?
A malpractice settlement or court judgment that includes a stipulation that the terms are kept confidential. Yes A malpractice settlement is structured so that the claimant receives an annual sum for each year he or she is alive. Yes
Must report within 30 days of the initial payment stating the total amount awarded. The multiple payments should be explained in the narrative.
A malpractice settlement that involves multiple practitioners that are named in the claim and named in the release. Yes
A separate report must be submitted for each practitioner.
A payment made as the result of oral demands. No
A payment made by an individual out of personal funds. No
A medical malpractice payment made by a professional corporation or other business entity composed of a sole practitioner (who
was named in the complaint and the settlement). Yes
A medical malpractice payment made solely for the benefit of a corporation such as a clinic, group practice, or hospital. No
A malpractice payment made for the benefit of a licensed resident or intern. Yes
A practitioner’s fee refunded by an entity (including a solo incorporated practitioner) as the result of a written demand. Yes A practitioner’s fee refunded by the individual practitioner out of personal funds as the result of a written demand. No A practitioner defendant released from a medical malpractice lawsuit as a condition of settlement. Yes A practitioner defendant dismissed from a lawsuit, without condition, prior to settlement or judgment. No A medical malpractice payment made for the benefit of a practitioner who settled out of court. Yes An insurance company’s reimbursement to a practitioner for a medical malpractice payment the practitioner made out of pocket
to a patient as a result of a written complaint. Yes
A payment made for the benefit of an unlicensed medical resident. No
A payment made on behalf of an unlicensed student practitioner. No
NPDB Guidebook Chapter E: Reports
April 2015
Q&A: Reporting Medical Malpractice Payments
1. The authorized submitter for a medical malpractice payer found documentation of reportable payments that were not reported to the NPDB. What should the authorized submitter do?
The authorized submitter should submit reports on those payments to the NPDB.
2. Do medical malpractice payers have to report payments made for the benefit of a deceased practitioner?
Yes. Medical malpractice payers must submit reports of payments made for the benefit of deceased practitioners because fraudulent practitioners may seek to assume the identity of a deceased practitioner. One of the principal objectives of the NPDB is to restrict the ability of incompetent practitioners to move from State to State without disclosing their previous damaging or incompetent performance.
3. How should a payment be reported to the NPDB if a total amount has not been determined and the payer is making an initial partial
payment?
Complete the MMPR screens according to the instructions in the IQRS.
Note the amount of the first payment and, in the narrative section, explain that the total amount has not been determined and the first payment is a partial payment. When the final amount is determined, submit a Correction Report, update the “Total Amount Paid” section of the report, and explain the additional payment in the narrative section.
4. Should a payment exclusively for the benefit of a clinic, hospital, or other health care entity be reported?
No. Medical malpractice payments made solely for the benefit of a clinic, hospital, or other health care entity should not be reported to the NPDB.
However, a payment made for the benefit of a professional corporation or business entity consisting only of a sole practitioner is reportable to the NPDB.
E-26
April 2015
5. What are the NPDB reporting requirements for self-insured employers who provide professional liability coverage for their employed health care practitioners?
Self-insured entities have the same reporting responsibilities as all other medical malpractice payers. Employers that are self-insured and provide their employees professional liability coverage must report medical malpractice payments they make for the benefit of their employees.
6. If a patient makes an oral demand for payment for damages, should the resulting payment be reported to the NPDB?
No. Only payments resulting from written demands must be reported to the NPDB. Even if the practitioner transmits the demand in writing to the medical malpractice payer, the payment should not be reported if the patient’s only demand was oral. However, if a subsequent written claim or demand is received from the patient and then a payment is made by an entity (including a solo incorporated practitioner), that payment must be reported.
7. A patient made a written demand for a refund for services and, in response, the practitioner made the payment out of her personal funds.
Should the payment be reported to the NPDB?
No. A refund made by an individual out of personal funds should not be reported to the NPDB. However, if the practitioner’s malpractice insurer reimburses the practitioner for her out-of-pocket expenses, the insurer must report the payment.
8. Following an unsuccessful course of treatment, a patient and a
practitioner enter into a State-sponsored voluntary series of discussions in an attempt to settle their disagreement before resorting to litigation.
The discussions lead to the practitioner’s insurance company making a money payment to the patient to settle the dispute. Should this money payment be reported to the NPDB?
It depends. If, during the course of discussions, the patient made a written complaint or written claim demanding a monetary payment for damages, the payment must be reported. If the complaint or claim for damages was never put in writing, the payment is not reportable.
9. If an individual practitioner is not named, identified, or described in a
E-27
NPDB Guidebook Chapter E: Reports
April 2015
medical malpractice claim or complaint, but the facility or practitioner group is named, should the payment be reported?
No, with one exception. If the named defendant is a sole practitioner identified as a “professional corporation,” a payment made for the professional corporation must be reported for the practitioner.
10. A supervisory practitioner is named in an action based on the services of a subordinate practitioner, and payments are made for the benefit of the supervisor and the subordinate. How should the payments be reported to the NPDB?
Separate reports must be submitted for the supervisory and subordinate practitioners. The report on the supervisory practitioner should be submitted using the same malpractice claim description code used in the subordinate practitioner’s payment report. The reporting entity should use the narrative description to explain that the supervisory practitioner was named based on the subordinate practitioner’s services.
11. If a stipulation of settlement or court order requires that terms remain confidential, how does a medical malpractice insurer report the
payment to the NPDB without violating the settlement agreement or court order?
Confidential terms of a settlement or judgment do not excuse an entity from the statutory requirement to report the payment to the NPDB or from providing a narrative describing the payment. The reporting entity should explain in the narrative section of the reporting format that the settlement or court order stipulates that the terms of the settlement are confidential.
12. If there is no medical malpractice payment and Loss Adjustment Expenses (LAEs) are paid in order to release or dismiss a health care practitioner from a medical malpractice lawsuit, should the LAEs be reported?
No. LAEs refer to expenses other than those in compensation of injuries, such as attorney fees, billable hours, expert witness fees, and deposition and transcript costs. If LAEs are not included in the medical malpractice
payment, then they should not be reported to the NPDB. LAEs should be reported only if they are part of the total medical malpractice payment and, when reported, should be explained in the narrative description.
E-28
April 2015
13. Does a medical malpractice payment have to exceed a certain dollar amount before it is reportable to the NPDB?
No. There is no minimum payment amount threshold. Medical malpractice payments of any amount that meet the reporting criteria should be reported to the NPDB.
14. A defendant health care practitioner agreed to settle a medical
malpractice claim in exchange for being dismissed from a lawsuit. All parties involved in the lawsuit agreed to the condition. Should the resulting payment be reported to the NPDB?
Yes. Because the payment is the result of the condition that the defendant health care practitioner be dismissed from the lawsuit, the payment can only be construed as a payment for the benefit of the health care practitioner and must be reported to the NPDB.
15. A hospital and a health care practitioner were named in a medical malpractice claim. Further review revealed that the practitioner had never treated the plaintiff who filed the claim. The practitioner was dismissed from the lawsuit without condition. A settlement on behalf of the hospital was reached and a payment was made to the plaintiff to resolve the claim. The release stated that the defendant health care practitioner was dismissed from the lawsuit prior to settlement and the payment was being made on behalf of the hospital. Is this payment reportable to the NPDB?
No. Because the health care practitioner had been dismissed from the action independently of the settlement or release, the payment cannot be viewed as being made for the benefit of the health care practitioner. The payment made on behalf of the hospital should not be reported to the NPDB.