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NPDB Dispute Resolution – Tell Your Side

The National Practitioner Data Bank (NPDB)

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. The negative reports submitted to the NPDB 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, a NPDB report can have a devastating effect on the career of a physician or other health care provider who is unlucky enough to be the subject of such a report. The real-world consequences of being the subject of a 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 a 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.

Disputing Nation Practitioners Data Bank Reports

The NPDB has a dispute resolution process that permits the subject of a 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 is 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 a 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 a NPDB report absolutely should assist in the preparation of a clear and concise NPDB Subject Statement. The NPDB permits any practitioner who has received a 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 space, because spaces and punctuation are included, there is a great deal of thought, planning and editing that must be part of drafting a Subject Statement.

We Can Help

Any physician confronted with a NPDB report should seek representation by an attorney experienced in the dispute resolution process and preparing NPDB Subject Statements. If you are a physician with a NPDB report, please contact Aaron Kemp, Senior Attorney and Chairperson of the Professional Licensing & Regulatory Affairs Group at Chapman Law Group, for representation. Mr. Kemp has represented physicians and other health professionals in NPDB matters for over 15 years and has successfully disputed NPDB reports and negotiated resolutions with reporting entities that have included corrections and voiding of NPDB reports.

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Related Attorney

Aaron J. Kemp

Senior Attorney

Chairperson of Professional Licensing & Regulatory Affairs

Michigan Office
1441 West Long Lake Rd., Ste. 310
Troy, MI 48098
Phone: (248) 644-6326

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