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Reporting Requirements to Government Agencies. Stacey A. Borowicz, Esq. Dinsmore & Shohl LLP 191 W. Nationwide Blvd. Suite 300 Columbus, OH 43215 (614) 227-4212 stacey.borowicz@dinslaw.com. November 6, 2008. Reporting Requirements to Government Agencies. Presentation Outline:

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Reporting Requirements to Government Agencies

Stacey A. Borowicz, Esq.

Dinsmore & Shohl LLP

191 W. Nationwide Blvd.

Suite 300

Columbus, OH 43215

(614) 227-4212

stacey.borowicz@dinslaw.com

November 6, 2008

reporting requirements to government agencies
Reporting Requirements to Government Agencies

Presentation Outline:

  • Reporting Obligations Arising From Peer Review, Quality Assurance, and Utilization Committees
  • The National Practitioner Databank
  • The Basics of Reporting Professional Misconduct
  • Responding to Government Subpoenas
  • Miscellaneous Reporting Obligations
peer review reporting obligations
Peer Review & Reporting Obligations
  • Peer Review Materials Are Generally Treated as Confidential (O.R.C. 2305.252)
  • WHY: to encourage the free flow of information (Browning v. Burt (1993), 66 Ohio St.3d 544, 613 N.E.2d 993)
peer review reporting obligations4
Peer Review & Reporting Obligations

The Definition of a Peer Review Committee:

“. . . a utilization review committee, quality assessment committee, performance improvement committee, tissue committee, credentialing committee, or other committee that does either of the following.” O.R.C. 2305.25.

peer review reporting obligations5
Peer Review & Reporting Obligations

What is Protected from Discovery or Introduction as

Evidence?

  • Peer review proceedings and records
  • Testimony from any individual that attends a meeting, serves as a member, works for, provides information to a peer review committee
  • See O.R.C. 2305.252 and Gates v. Brewer (1981), 2 Ohio App.3d 347, 442 N.E.2d 72.
peer review reporting obligations6
Peer Review & Reporting Obligations

Caution:

Some Exceptions Exist That Allow

Discovery and Introduction as Evidence

(O.R.C. 2305.252)

  • Original sources
  • Personal knowledge
peer review reporting obligations7
Peer Review & Reporting Obligations

Special Issue:

Incident / Risk Management Reports

  • What are they?
  • Is there an Incident Report statute?
  • How do we use them?
peer review reporting obligations8
Peer Review & Reporting Obligations

Keys to the Proper and Safe Use of Incident Reports:

  • The Incident Report Must Have Been Prepared for Use by the Peer Review Committee.
  • Merely labeling something an “Incident Report” is not enough.
  • See Manley v. Heather Hill, Inc. (2007), 175 Ohio App.3d 155, 885 N.E.2d 971, 2007-Ohio-6944.
peer review reporting obligations9
Peer Review & Reporting Obligations

Question:

What particular kind of

information belongs in

incident reports?

Answer:

All the subjective stuff that

should never make it into a

medical record.

peer review reporting obligations10
Peer Review & Reporting Obligations

Practical Advice:

  • Develop and Maintain Peer Review Committee Formalities
  • Use Incident Reports That Are Created
  • Investigate Related Matters
  • Develop Policies and Educate Staff on What Should Be Included in Incident Reports
the national practitioner data bank
The National Practitioner Data Bank

What Gets Reported:

(42 C.F.R. 60.6-60.9)

  • Malpractice Payments
  • Licensure Actions
  • Adverse Actions
  • Reporting Errors, Omissions, and Revisions

When It Gets Reported:

(42 C.F.R. 60.5)

  • The above items must be reported within 30 days.
the national practitioner data bank12
The National Practitioner Data Bank

Reporting Medical Malpractice Payments:

(42 C.F.R. 60.7)

Who Gets Reported: physicians, dentists, other health care

practitioners (those licensed by a state providing health care

services)

Who Reports: the entities and insurance companies that make

payments for the benefit of the practitioner in satisfaction of a

settlement or judgment

To Whom is Information Reported: the appropriate state licensing

board and to the NPDB

the national practitioner data bank13
The National Practitioner Data Bank

Reporting Medical Malpractice Payments:

(42 C.F.R. 60.7)

What is Reported:

(1) the practitioner’s information

(2) the reporting entity’s information

(3) claim, conduct, settlement or judgment information

the national practitioner data bank14
The National Practitioner Data Bank

Reporting Licensure Actions:

(42 C.F.R. 60.8)

Who Gets Reported: physicians and dentists

Who Reports: relevant Board of Medical Examiners

To Whom is Information Reported: NPDB

What Gets Reported: revocation, suspension, or surrender of the license, as well as censures, reprimands, or probation

Other Reported Information: practitioner information

the national practitioner data bank15
The National Practitioner Data Bank

Reporting Adverse Actions on Clinical Privileges:

(42 C.F.R. 60.9)

Who Gets Reported: physicians and dentists (must report); other health care practitioners (may report)

Who Reports: entities that take adverse actions

First Level of Reporting: the entity to the Board of Medical Examiners

What Gets Reported: actions affecting privileges for longer than 30 days, accepted surrender or restriction of privileges during investigation

the national practitioner data bank16
The National Practitioner Data Bank

Reporting Adverse Actions on Clinical Privileges:

(42 C.F.R. 60.9)

Other Reported Information: practitioner information

Second Level of Reporting: the Board of Medical Examiners to NPDB

What Gets Reported: the information reported to the board by the health care entities, and any known instances of a health care entity’s failure to report information for adverse actions taken with respect to clinical privileges

professional misconduct
Professional Misconduct

State Medical Board:

(OAC 4731-15-02)

Who Reports: the chief administrative or executive officer

Individual Subject to Reporting: physician assistants, physicians,

limited practitioners, anesthesiologists, acupuncturists

To Whom is Information Reported: the State Medical Board of Ohio

What Gets Reported: any “formal disciplinary action”

professional misconduct18
Professional Misconduct

Board of Nursing:

(O.R.C. 4823.34)

Who Reports: employers

Individual Subject to Reporting: nurses, LPNs, dialysis technicians,

certified community health workers, medication aids

To Whom is Information Reported: State Board of Nursing

What Gets Reported: professional misconduct under Nurse Practice Act

responding to subpoenas
Responding to Subpoenas

Definition:

Subpoenas are a legal command, not a court order,

that request testimony or the production of documents

Types of Subpoenas:

subpoena ad testificandum: requires attendance of witness at a hearing, deposition, or trial

subpoena duces tecum: requires the production or copying of documents

Issuers:

attorneys, arbitrators, government boards / commissions, judges, grand juries

responding to subpoenas20
Responding to Subpoenas

Procedure for Handling a Subpoena:

  • Don’t Panic
  • Read the Subpoena
  • Contact Your Attorney
miscellaneous reporting requirements
Miscellaneous Reporting Requirements

Ohio Department of Health:

Birth Defects: R.C. 3705.30-31

Cancer: R.C. 3701.261-262

HIV/AIDS: R.C. 3701.24

Protective Reporting:

Child Abuse: R.C. 2151.421

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Stacey A. Borowicz, Esq.Dinsmore & Shohl LLP191 W. Nationwide Blvd.Suite 200Columbus, Ohio 43215stacey.borowicz@dinslaw.com