An adjudicated action or decision is not reportable unless a due process mechanism was available to the practitioner to challenge the proposed action, whether or not the practitioner actually exercised its rights to do so. Because the OIG broadly defined this category and did not provide many clear examples, the burden falls on the reporting entity to determine whether a report is required. Health plans may elect to err on the side of over-reporting. In the meantime, entities should consider querying the data bank on a regular basis to ensure that information regarding them is correct. These entities also can obtain information on other excluded providers through the OIG's web site which is accessible to the public.
Queries are at the discretion of eligible entities.
There does not appear to be any provision, however, that prohibits a health care provider from sharing a self-queried report with another entity if it chooses. Whether a hospital could require a self-queried report from a practitioner remains an open question. The Secretary of DHHS will establish and approve reasonable fees for the disclosure of information in the database. For the purposes of verification and dispute resolution, however, subjects of reports will receive a report automatically and free of charge. The subject of a report may dispute the filing of a report or information that is factually incorrect by first attempting to resolve the disagreement with the reporting entity.