45 C.F.R. § 60.13

Reporting Federal or state criminal convictions related to the delivery of a health care item or service

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(a) Who must report. Federal and state prosecutors must report criminal convictions against health care practitioners, providers, and suppliers related to the delivery of a health care item or service (regardless of whether the conviction is the subject of a pending appeal).

(b) What information must be reported. Entities described in paragraph (a) of this section must report the following information:

(1) If the subject is an individual, personal identifiers, including:

(i) Name,

(ii) Social Security Number (or ITIN) (states must report this information, if known, and if obtained in accordance with section 7 of the Privacy Act of 1974),

(iii) Home address or address of record,

(iv) Sex, and

(v) Date of birth.

(2) If the subject is an individual, that individual's employment or professional identifiers, including:

(i) Organization name and type,

(ii) Occupation and specialty, if applicable, and

(iii) National Provider Identifier (NPI).

(3) If the subject is an organization, identifiers, including:

(i) Name,

(ii) Business address,

(iii) Federal Employer Number (FEIN), or Social Security Number (or ITIN) when used by the subject as a Taxpayer Identification Number (TIN),

(iv) The NPI, and

(v) Type of organization.

(4) For all subjects:

(i) A narrative description of the acts or omissions and injuries upon which the reported action was based,

(ii) Classification of the acts or omissions in accordance with a reporting code adopted by the Secretary,

(iii) Name and location of court or judicial venue in which the action was taken,

(iv) Docket or court file number,

(v) Type of action taken,

(vi) Statutory offense(s) and count(s),

(vii) Name of primary prosecuting agency (or the plaintiff in civil actions),

(viii) Date of sentence or judgment,

(ix) Length of incarceration, detention, probation, community service, or suspended sentence,

(x) Amounts of any monetary judgment, penalty, fine, assessment, or restitution,

(xi) Other sentence, judgment, or orders,

(xii) If the action is on appeal,

(xiii) Name and address of the reporting entity, and

(xiv) The name, title, and telephone number of the responsible official submitting the report on behalf of the reporting entity.

(c) What information may be reported, if known. Entities described in paragraph (a) of this section and each state should report, if known, the following information:

(1) If the subject is an individual, personal identifiers, including:

(i) Other name(s) used,

(ii) Other address(es), and

(iii) FEIN, when used by the individual as a TIN.

(2) If the subject is an individual, that individual's employment or professional identifiers, including:

(i) State professional license (including professional certification and registration) number(s), field(s) of licensure, and the name(s) of the state or territory in which the license is held,

(ii) Other numbers assigned by Federal or state agencies, including, but not limited to DEA registration number(s), Unique Physician Identification Number(s) (UPIN), and Medicaid and Medicare provider number(s);

(iii) Name(s) and address(es) of any health care entity with which the subject is affiliated or associated, and

(iv) Nature of the subject's relationship to each associated or affiliated health care entity.

(3) If the subject is an organization, identifiers, including:

(i) Other name(s) used,

(ii) Other address(es) used,

(iii) Other FEIN(s) or Social Security Numbers(s) (or ITINs) used,

(iv) Other NPI(s) used,

(v) State license (including certification and registration) number(s) and the name(s) of the state or territory in which the license is held,

(vi) Other numbers assigned by Federal or state agencies, including, but not limited to DEA registration number(s), Clinical Laboratory Improvement Act (CLIA) number(s), Food and Drug Administration (FDA) number(s), and Medicaid and Medicare provider number(s),

(vii) Names and titles of principal officers and owners,

(viii) Name(s) and address(es) of any health care entity with which the subject is affiliated or associated, and

(ix) Nature of the subject's relationship to each associated or affiliated health care entity.

(4) For all subjects:

(i) Prosecuting agency's case number,

(ii) Investigative agencies involved,

(iii) Investigative agencies case or file number(s), and

(iv) The date of appeal, if any.

(d) Access to documents. Each state must provide the Secretary (or an entity designated by the Secretary) with access to the documents underlying the actions described in paragraphs (a)(1) through (4) of this section, as may be necessary for the Secretary to determine the facts and circumstances concerning the actions and determinations for the purpose of carrying out section 1921.

(e) Sanctions for failure to report. The Secretary will provide for publication of a public report that identifies those agencies that have failed to report information on criminal convictions as required to be reported under this section.

[78 FR 20484, Apr. 5, 2013, 78 FR 25860, May 6, 2013]

Notes of Decisions

Cited in 9 cases (1 in the last 5 years), 1999–2021 · leading case: Director of Health Affairs Policy Planning v. Freedom of Information Commission

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Director of Health Affairs Policy Planning v. Freedom of Information Commission (2009) conn · cites it 13× “The commission also rejected the plaintiff's claim that four of the requested records labeled IC-2006-098-20 through IC-2006-098-23 and IC-2006-098-33 were exempt from disclosure pursuant to 45 C.F.R. § 60.13 (a). In rejecting the plaintiff's claim, the commission relied on…”

Wahi v. Charleston Area Medical Center, Inc. (2009) ca4 · cites it 2× “Breach of Confidentiality Wahi’s last argument is that the district court erred in dismissing his state law “breach of confidentiality” claim because 45 C.F.R. § 60.13 prohibited CAMC from disclosing to the local news media the fact that it had reported Wahi to the NPDB.”

Troescher v. Grody (2005) pasuperct · cites it 5× “and 45 C.FR. 60.13; and b. Documents deemed confidential by the Pennsylvania Peer Review Protection Act, 63 P.”

Wheeler v. Methodist Hospital (2002) texapp “See 45 C.F.R. § 60.13 (a),(b) (West 2000). Reports to the Data Bank may also be disclosed to an attorney, or an individual representing himself, in a claim for medical malpractice against a hospital or physician.”

Doe v. Community Medical Center, Inc. (2009) mont · cites it 2× “45 C.F.R. § 60.13 ; 23 NPDB Guidebook, A-3.”

Fallis v. Watauga Medical Center, Inc. (1999) ncctapp “3791 (1986) and 45 C.F.R. § 60.13 . Plaintiffs do not take issue with this analysis.”

Commissioner of Public Health v. Freedom of Information Commission (2014) conn · cites it 6× “) 45 C.F.R. § 60.13 (a) (2009). Several years after it created the Practitioner Data Bank, Congress enacted the Health Insurance Portabil- ity and Accountability Act of 1996 (1996 federal act),6 in which it authorized the creation of the Healthcare Data Bank—‘‘a national health…”

Leadbitter v. Keystone; Apl: St. Clair Hosp (2021) pa “Instead, they quote an outdated regulation, previously set forth at 45 C.F.R. §60.13 (a), that lacks the clarifying language emphasized above.”

Doe v. Community Medical Center (2009) mont “45 C.F.R. § 60.13 ; 23 NPDB Guidebook, A-3.”

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