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FAQs About Claims Data Reporting

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kc_faq_claimsdata

FAQs About Claims Data Reporting

Related to: Claims, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery


Show All Answers

Q: Who has access to my malpractice claims information?

A:

From CRICO

Physicians may request their own CRICO claims history.

 

Institutions where you are credentialed or privileged can request access to your 10-year CRICO claims history but they must have your signed approval before records will be released. The following information is provided:

  • the date a claim was made
  • a brief description of the case
  • the current status.

 

From the National Practitioner Data Bank (NPDB)

  • Health care entities (including hospitals) that have entered or may be entering into employment or affiliation relationships with a practitioner or to which the practitioner has applied for clinical privileges or appointment to the medical staff, or with respect to professional review activity.
  • Practitioners requesting information about themselves.
  • Boards of medical examiners or other state licensing boards.
  • Attorneys or individuals representing themselves upon submission of proof that a hospital failed to submit a mandatory query.
  • Persons or entities requesting information in a form which does not identify any particular entity or practitioner. For example, data for statistical analysis purposes are available on the NPDB’s website for download. The Data Analysis Tool allows researchers to define and generate de-identified data sets for NPDB reports submitted on practitioners from 1990 through the end of the most recent calendar year.

 

From Medical Licensing Boards in Massachusetts

  • Malpractice history is available from the Board of Registration in Medicine (BORIM) to state and federal law enforcement agencies for investigative purposes.
  • Closed complaint files, which contain the complaint and other information in matters which have been dismissed or otherwise resolved without adjudication, are public records. (243 CMR 1.03).
  • If the BORIM formally investigates a malpractice report and makes findings, these are available to inquiring individuals.
  • An individual can find out from the BORIM if a malpractice action has passed the tribunal stage and been assigned a court docket number. A suit’s status can be ascertained by checking the docket number.
  • Each physician’s profile may contain information about the physician’s specialty, medical school, residency training, insurance plans accepted, honors/awards, publications and a host of other information. Profiles also include Board discipline, criminal convictions, hospital discipline and medical malpractice payments reported to the Board.

 

From Medical Licensing Boards in Other states

All states contain malpractice information that vary in their availability to the public. Some examples are listed below.

  • For instance, in Rhode Island, disciplinary actions are publicly available via the Department of Health.
  • Medical malpractice history, as reported to the Rhode Island Board of Medical Licensure and Discipline and the New Hampshire Registration Board in Medicine, is not accessible to individuals. After receiving reports of medical malpractice actions, either board may conduct an investigation of a physician. The formal agreement arising out of any actions taken by either board is published in the local newspaper and is available to individuals on written request.
  • In New Hampshire, settlement information is public record.

In all states, a verdict in a medical malpractice trial becomes a matter of public record.


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