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Who Can Query and Report to the NPDB?
| Entity | Query | Report |
|---|---|---|
| Medical malpractice payers | Prohibited | Required |
| Hospitals | Required* | Required |
| Health care entities with formal peer review | Optional | Required |
| Professional societies with formal peer review | Optional | Required |
| Boards of Medical Examiners (State Medical and Dental Boards) | Optional | Required |
| Other State Licensing Boards | Optional | No Requirement |
| Drug Enforcement Administration | Prohibited | Required |
| HHS Office of Inspector General | Prohibited | Required |
| Entity | Query | Report |
|---|---|---|
| Hospitals* | Optional** | No Requirement |
| Health care entities with formal peer review | Optional** | No Requirement |
| Health plans | Optional | Required (1128E) |
| Professional societies with formal peer review | Optional** | No Requirement |
| Quality Improvement Organizations | Optional** | No Requirement |
| State Licensing and Certification Authorities | Optional | Required (1921) |
| Peer review organizations | Prohibited | Required (1921) |
| Private accreditation organizations | Prohibited | Required (1921) |
| State law enforcement agencies*** | Optional | Required (1921) |
| State Medicaid Fraud Control Units*** | Optional | Required (1921) |
| State agencies administering or supervising the administration of state health care programs*** | Optional | Required (1921) |
| Agencies administering Federal health care programs, including private entities administering such programs under contract | Optional | Required**** (1128E) |
| Federal licensing and certification agencies | Optional | Required**** (1128E) |
| Federal law enforcement officials and agencies | Optional | Required**** (1128E) |
* Under Title IV, hospitals must query when physicians, dentists, and other health care practitioners apply for medical staff appointment (courtesy or otherwise) or for clinical privileges, and every two years on physicians, dentists, and other health care practitioners who are part of the medical staff or who hold privileges.
** These entities are not authorized to receive exclusions, criminal convictions, civil judgments, and other adjudicated actions or decisions that are reported under Section 1921.
*** The NPDB regulations define "state law or fraud enforcement agency" to include but not to be limited to these entities.
**** Section 1128E requires reporting by "Federal Government agencies," as specified in the regulations.
NPDB: Who Can Report and Query?
An infographic that provides a list who can report and query to the NPDB.
See the full infographic