[Code of Federal Regulations]

[Title 45, Volume 1]

[Revised as of October 1, 2006]

From the U.S. Government Printing Office via GPO Access

[CITE: 45CFR61.8]



[Page 153-154]

 

                        TITLE 45--PUBLIC WELFARE

 

                    SUBTITLE A--DEPARTMENT OF HEALTH

                           AND HUMAN SERVICES

 

PART 61_HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE 

INFORMATION ON HEALTH CARE PROVIDERS, SUPPLIERS AND PRACTITIONERS--Table 

of Contents

 

                   Subpart B_Reporting of Information

 

Sec.  61.8  Reporting Federal or State criminal convictions related to the 

delivery of a health care item or service.



    (a) Who must report. Federal and State prosecutors must report 

criminal convictions against health care providers, suppliers, and 

practitioners related to the delivery of a health care item or service 

(regardless of whether the conviction is the subject of a pending 

appeal).

    (b) 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);

    (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), when issued by theCenters 

for Medicare & Medicaid Services (CMS).

    (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, when issued by CMS; 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) Entities described in paragraph (a) of this section 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; 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, to 

include, but not limited to Drug Enforcement Administration (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



[[Page 154]]



    (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, to 

include, but not limited to Drug Enforcement Administration (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 of file number(s); and

    (iv) The date of appeal, if any.

    (d) Sanctions for failure to report. The Secretary will provide for 

publication of a public report that identifies those Government agencies 

that have failed to report information on criminal convictions as 

required to be reported under this section.



[64 FR 57758, Oct. 26, 1999, as amended at 69 FR 33868, June 17, 2004]