Dispute Resolution: Tell Your Side Over a Negative NPDB Report

The Real-World Consequences of an NPDB Report Can Damage Your Career. Here’s What to Know

It is difficult to imagine an acronym more loathsome to physicians than NPDB.

The National Practitioner Data Bank (NPDB) was created as part of the Health Care Quality Improvement Act of 1986 (HCQIA). It is a non-public online database of negative event reports involving physician, dentists and other licensed health care providers.

A negative NPDB report can take many forms, including, but not limited to:

    • Adverse clinical privileging/credentialing actions
    • Adverse professional licensure actions
    • Medical malpractice payments, either following a trial or via settlement
    • Adverse private accreditation organization actions
    • Adverse actions or findings by federal or state licensing or certification agencies
    • Adverse civil or criminal judgments/convictions that are related to health care
    • Exclusion from a state or federal health care program

While not a public database, NPDB reports are made available to hospitals, health plans, state licensing boards and other entities such as independent physician organizations. Thus, an NPDB report can have a devastating effect on the career of a physician or other health care provider who is unfortunate enough to be the subject of such a report.

The real-world consequences of being the subject of an NPDB report can include exclusion from health plans and independent physician organizations, denial or restriction of medical staff privileges, increases to professional liability insurance premiums, licensing investigations and/or potential licensing sanctions.

However, if you are the subject of an NPDB report, there are several actions you should take to correct any errors in the report, provide your side of the events portrayed in the report and, if possible, void the report in its entirety.

Chapman Law Group’s Aaron Kemp discusses the National Practitioner Data Bank; reporting administrative actions; peer reviews and what federal immunity under the Healthcare Quality Improvement Act is about; summary suspensions; and other things licensing matters.

How the NPDB Dispute Resolution Process Works

The NPDB has a dispute resolution process that permits the subject of an NPDB report to dispute the report, but only on the basis that the report was factually erroneous or if the subject matter of the report was not a reportable event under the NPDB regulations codified in the Code of Federal Regulations. The NPDB will not address any allegations that an underlying credentialing matter did not provide adequate due process or that the allegations in a medical malpractice case were frivolous.

The first steps in this process are placing the NPDB into dispute status and sending a detailed and well-reasoned request to the reporting entity to correct factual inaccuracies in the report or void it in its entirety because the matter was not a reportable event. At this stage, it is crucial to enlist the guidance of experienced legal counsel who are familiar with the Code of Federal Regulations applicable to the NPDB and which events are reportable to the NPDB and which are not, to prepare such a request.

Sixty days after the request is made, if adequate relief is not obtained or they fail to respond at all, the matter will be elevated to dispute resolution status and an NPDB Dispute Resolution Manager will make a final determination regarding whether the report should be corrected or voided. If adequate relief is still not obtained, the matter can be further elevated for reconsideration by the Department of Health and Human Services.

While the dispute resolution process is vitality important to pursue, any practitioner who is the subject of an NPDB report absolutely should assist in the preparation of a clear and concise NPDB Subject Statement. The NPDB permits any practitioner who has received an NPDB report to prepare a 4,000-character Subject Statement that will be included in the report for any entity viewing in the future and will be provided to any entity which viewed the report in the past three years.

This is your only opportunity to address the specific subject matter of the report and make certain the true facts are exposed to scrutiny. While 4,000 characters may seem like a lot of room, keep in mind that spaces and punctuation are included as characters — meaning there is a great deal of thought, planning and editing needed when drafting a Subject Statement.

Turn to the National Healthcare Attorneys at Chapman Law Group to Help with Disputes Over an NPDB Report

Any physician confronted with an NPDB report should seek representation by an attorney experienced in the dispute resolution process and preparing NPDB Subject Statements.

Our professional licensing and regulatory affairs attorneys at Chapman Law Group have successfully disputed NPDB reports and negotiated resolutions with reporting entities — including corrections and voiding of NPDB reports.

For 35 years, we at Chapman Law Group have focused solely on clients and matters within the healthcare sector across the U.S. We work with physicianspain management specialistsnurses and nurse practitioners, and other licensed healthcare professionals.

Our four national healthcare defense law offices are in Detroit, MichiganMiami and Sarasota, Florida; and Los Angeles/Southern California. Contact us today.

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Aaron J. Kemp

Senior Attorney

Chairperson of Professional Licensing & Regulatory Affairs

Michigan Office
1441 W. Long Lake Road, Suite 310
Troy, MI 48098
Phone: (248) 644-6326

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