The National Practitioner Data Bank (NPDB) was implemented by Congress in order to improve the quality of medical care, and to restrict the ability of practitioners with a problematic past from moving state-to-state and billing government health care programs.
The regulations that govern the NPDB are laid out in 45 CFR part 60 and were implemented as a result of the Health Care Quality Improvement Act of 1983, 42 U.S.C. 11101 et seq. The NPDB requires certain entities to report any negative action taken against a health care practitioner within 15 days of a final action or summary suspension.
Initiatives by Health Resources and Services Administration (March 2010) make it clear the NPDB is trying to achieve full compliance from all reporting sources. In 2010, HRSA publicly posted the compliance status for nurses, pharmacists, physician assistants, psychologists and social workers. In 2012 all behavioral health professionals were added to the compliance status.
In 2013, HRSA announced that it was focusing on the 12 most queried professionals:
That same year, the NPDB and the Healthcare Integrity and Protection Data Bank were consolidated into the NPDB.
The National Practitioner Data Bank reporting entities are:
The main reporting entities that affect most health care professionals are insurance carriers or anyone who makes an indemnity payment on behalf of the health care provider, hospitals or health care employers and state licensing boards.
With respect to insurance indemnity payments, the general rule is you may report any payment made on your behalf to release you from a lawsuit. In the past, physicians would be released and the hospital or corporations would assume liability to avoid reporting. This practice is no longer allowed. The payor must report the payment to the NPDB regardless of the amount.
As for discipline, when a health care practitioner faces disciplinary action by their state licensing board, summary/emergency suspension of their license, or action taken by a credentialing body, a report must be sent to the NPDB within 15 days.
Therefore, it is important to understand that when a physician, dentist, nurse, physician assistant or other health care practitioner is facing a licensing or credentialing issue, they must contact a knowledgeable health law attorney. A health care layer will work with you to limit or reduce the discipline, which results in no reporting or a more favorable report to the NPDB.
Negative information on the NPDB has the ability to ruin a health care practitioner’s career. Often, a practitioner with even one negative report can become excluded from billing large insurance companies and Medicare; face subsequent state licensing actions; and find it difficult to gain or maintain staff privileges. Health practitioners must exhaust every remedy to prevent damaging information from being disseminated to the NPDB.
Reports to the NPDB are permanent, but they may be appealed through a dispute process, and the subject of the report may also file a statement explaining the report. Initially, NPDB disputes must be taken up with the reporting entity.
The NPDB will not handle disputes with the substance of a NPDB report. If the reporting entity fails to change the report after a request, the subject may request review of the report by the Secretary of HHS. The Secretary reviews reports only for accuracy of the factual information and to ensure that the information was required to be reported.
The NPDB dispute review process is highly technical. It requires the knowledge and skill of an experienced health law attorney. Practitioners should be cautioned from filing disputes on their own with the Secretary of HHS. This is because, after an initial dispute is filed, the subject is unlikely to be granted a second review. There is no formal NPDB appeals process for reconsideration of a Secretary’s review.
If you have received or are about to receive a negative National Practitioner Data Bank report and wish to appeal, you should contact Chapman Law Group immediately. Our experienced health law attorneys can fight to prevent damaging information from being shared on the NPDB and protect your rights during the appeals process.
For 35 years, we at Chapman Law Group have focused solely on clients and matters within the healthcare sector. We work with physicians, pain management specialists, nurses and nurse practitioners, and other licensed healthcare professionals across the U.S. on NPDB-related matters.
With national offices in Detroit, Michigan; Miami and Sarasota, Florida; and Los Angeles/Southern California, we are here to advise on NPDB defense. Call us for a consultation.
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