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Oct 1 2011

Taking the mystery out of reporting malpractice payments

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It’s been nearly two years since the NC Medical Board implemented statutory changes that require it to collect and post certain malpractice information on its website. These changes affect a small fraction of the Board’s licensees. In fact, in 2010 the NCMB received malpractice payment reports from less than one percent of the Board’s total active licensee population. Just over half met criteria for posting on the NCMB’s website.

It is clear, though, that the small number of licensees who have had payments remain uncertain about the obligation to report this information to the Board.

The NCMB receives telephone calls on an almost daily basis from licensees seeking guidance. Many are confused about which malpractice payments require reporting, how and when to report payments, what specific details should be reported and, finally, what information will appear on the licensee’s online information page on the website. This article attempts to answer those questions.

Which payments to report
Simply stated, all malpractice payments affecting or involving a licensee must be reported to the Board. This includes payments related to care provided to patients in other states, regardless of where the patient or physician is presently located. Payments made for care provided prior to a physician’s licensure in North Carolina also must be reported.

A payment must be reported to the Board regardless of whether it was reported to the National Practitioner’s Data Bank (NPDB). In addition, a payment report must be made to the Board even if the licensee was dismissed from the lawsuit and the payment was made on behalf of another defendant such as a group practice, hospital or other healthcare institution. To be blunt, it is not appropriate for a licensee who is employed by a hospital, health system or other entity to fail to report a payment made in the name of his or her employer if the payment stemmed from care provided by the licensee.

Rule of thumb: If in doubt, report. Every malpractice payment report received by the Board from a North Carolina based licensee is reviewed by NCMB staff, verified against primary sources (such as NPDB reports, or reports submitted by professional liability insurance companies) and screened to determine whether it meets criteria for posting on the NCMB’s website.

Finally, although insurance companies that are licensed to do business in North Carolina are required under state law to report malpractice payments to the Board within 30 days of the payment, this duty does not relieve the licensee from his or her personal obligation to report that payment.

How/when to report a payment
It’s important to understand that the NCMB collects malpractice information for two distinct and unrelated purposes. First, the Board has a duty to evaluate the care associated with each payment and make a determination if care met accepted and prevailing standards. Second, the Board is obligated to comply with state law, which makes certain information regarding malpractice payments public and sets criteria for posting that information on the NCMB’s website.

If a payment meets criteria for posting on the Board’s website, it must be reported within 60 days. Payments that are $75,000 or more and were made on or after May 1, 2008, meet posting criteria.

If the payment does not meet posting criteria, the licensee may wait to report the payment until his or her next license renewal (although certainly it may be reported at any time prior to this by going to the Board’s website and clicking on “Update Licensee Info Page” from the Home Page.)

There is an important exception to these reporting criteria for any licensed physician who does not have professional liability insurance. Such a licensee must report an award or settlement to the Board within 30 days regardless of whether the award or settlement meets criteria for posting on the website.

Licensees should also be aware that a pending appeal does not alter the 60 day reporting requirement, nor does the timing, sequence or structure of the payment.

Each malpractice payment should be reported to the Board by a licensee only once. For instance, if a malpractice payment is already listed on a licensee’s online renewal form it does not need to be reported again. On the other hand, if a licensee is aware of a malpractice payment (of any amount) made on his or her behalf that is not displayed on the malpractice section of the annual renewal, it should be reported.

What information should be reported
It is important to report all relevant information associated with care that resulted in a malpractice payment, regardless of whether the payment meets criteria for posting on the Board’s website. This is because, as stated in the previous section, the Board collects malpractice information both for investigative purposes and for public information purposes. A licensee should not omit details that may help inform the confidential investigation out of concern that those details will be posted on the public website.

The Board reviews the quality of care associated with every malpractice payment affecting or involving licensees with a North Carolina address. After reviewing the quality of care associated with a payment, the Board may take public action if it determines patient care was below accepted and prevailing standards. If the malpractice payment results in public Board action, that action will be posted, regardless of whether the payment itself meets criteria for posting on the website.

In 2010, 161 payments, or 54 percent of the total number of payments reported, met criteria for posting on the NCMB’s website. Malpractice information appears on the licensee’s individual information page (referred to as the “Licensee Information or LI page”) under the tabbed section labelled “Malpractice.” The specific information that appears is set by statute.

What will appear on the LI Page
Malpractice judgments and awards, regardless of amount, and settlements of $75,000 or more are displayed for seven years from the date of payment. A settlement is defined as an out of court agreement that resolves a claim of malpractice. A judgment or award follows a judicial decision or jury trial. A settlement of $75,000 or more is posted regardless of whether payment is made in a lump sum or in a series of payments (related to a single incident of alleged malpractice). In the context of this article, “payment” includes any payment that is made as a formal resolution to a claim of medical negligence or substandard care and includes judgments, awards, settlements or any other malpractice payment regardless of whether the payment is made from personal funds, by a third party on behalf of the licensee or from any other source.

A malpractice entry on the LI page includes the date of payment, the licensee’s specialty or area of practice, the city, state, and country in which the incident occurred and the date of the incident. The amount of the payment is not posted, nor is any information that might identify the patient, other practitioners or institutions involved in care. The licensee is permitted to submit a brief statement explaining the circumstances that led to the payment and whether the case is under appeal. Explanatory statements are displayed with the payment information as long as they conform to the ethics of the medical profession and do not contain information that discloses the amount of the payment or that would reveal the identity of the patient or any other health care professional. Appropriate explanations of the licensee’s involvement in the case are permitted; attempts to shift blame onto other practitioners or institutions are not.

In addition, the Board posts a statement that encourages the public to consider malpractice payment information in context and in combination with other information about the licensee’s education, training and professional experience. The website also states that a payment does not necessarily indicate that egligence has occurred, serve as evidence that care was substandard or constitute proof of incompetence, misconduct or an admission of wrongdoing on the part of the licensee. The public is advised that some licensees may have a higher than average incidence of payments due to their areas of practice, and is also informed that insurance carriers often settle cases without a finding of fault or admission of negligence by the licensee.

The Board recognizes the inherent complexity in properly reporting malpractice payments. Physicians and physician assistants are encouraged to communicate with their attorneys, their malpractice insurance companies or with NCMB staff when reporting a payment. Or, feel free to contact me directly. I am vailable by telephone at (919) 326-1109 x 247 or via .(JavaScript must be enabled to view this email address).

Click below for useful resources:
The Malpractice Reporting Decision Guide
Malpractice Reporting Examples

 Comments on this article:

What an awesome way to explain this-now I know everything!

By Jaydee on Oct 30, 2011 at 12:26am
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