The National Practitioner Data Bank

What are the reporting requirements and how do they impact your practice?GettyImages 513311684 1

The National Practitioner Data Bank (NPDB) is a federal information repository that tracks malpractice claims, disciplinary actions, state licensing actions, and privileging restrictions against U.S. health care practitioners.

Those practitioners include physicians, nurses, physician assistants, dentists, plus health care entities such as hospitals and practices.

According to the NPDB, "Congress enacted legislation leading to the creation of the NPDB because it perceived that the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care had become nationwide problems that warranted greater efforts than could be undertaken by any individual State." According to the federal government, the NPDB "is intended to improve the quality of health care by encouraging State licensing boards, hospitals, professional societies, and other health care organizations to identify and discipline those who engage in unprofessional behavior; to report medical malpractice payments; and to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history. Adverse actions can involve licensure, clinical privileges, professional society membership, and exclusions of Medicare and Medicaid."

Q: Why should ACR members care about the NPDB?

A: Radiology practices are required to report information to the NPDB. This information amounts to a report card or flagging system. Depending on the information, it can adversely affect a member's career.

Q: Who is required to make reports to the NPDB?

A: Information comes from medical malpractice payers, state health care practitioner licensing and certification authorities (including medical and dental boards), hospitals and other health care entities with formal peer-review processes (for example, HMOs, group practices, and managed care organizations), professional societies with formal peer-review processes (such as the ACR Ethics Committee), state entity licensing and certification authorities, peer-review organizations, and private accreditation organizations.

Q: What information is required to be reported?

A: The data bank tracks the following types of information:

• Medical malpractice payments by all health care practitioners
• Any adverse licensure actions, including revocation, reprimand, censure, suspension, and probation
• Any dismissal or closure of legal proceedings by reason of the practitioner or entity surrounding the license or leaving the state or jurisdiction
• Any other loss of license
• Adverse clinical privileging actions
• Adverse professional society membership actions
• Any negative actions or findings by a state licensing or certification authority
• Negative actions or findings by a peer review organization
• Negative actions or findings by a private accreditation organization

Q: Should organizations be concerned about being sued by providers or entities on which they submit reports?

A: Organizations that properly report information to the NPDB are protected from lawsuits regarding that information because authorized peer-review activity is involved.

Q: What happens if an organization fails to make a required report?

A: Failure to make a required report may result in civil monetary penalties or loss of peer-review immunity.

Q: Who can access information in the NPDB?

A: Information is available at the following entities:

• Hospitals and other health care entities and professional societies with formal peer review processes
• State health care practitioner licensing and certification authorities (including medical and dental boards)
• State entity licensing and certification authorities

Limited access is given to the following groups:

• State entity licensing and certification authorities
• Agencies or contractors administering federal health care programs
• State agencies administering state health care programs
• State Medicaid fraud control units
• The U.S. Comptroller General, the U.S. Attorney General, and other law enforcement agencies
• Plaintiff attorneys or plaintiffs acting as their own attorney
• Quality improvement organizations
• Researchers (who can access statistical data only)

Q: Can physicians and organizations view their own NPDB information?

A: Yes. Health care practitioners and organizations can self-query. This process allows practitioners or organizations to receive a report showing what, if any, information the NPDB contains about them. Before applying for a license, new employment, or new staff appointments or privileges, ACR members should always check the NPDB website via the self-query process on the NPDB website. This will provide the opportunity to contest or correct information before it is seen by a licensing organization or employer. However, a reporting entity has the right to leave its report unchanged.

Q: Who cannot access information in the NPDB?

A: The information in the data bank is not available to the general public. The NPDB cannot provide information on a specific practitioner, provider, or supplier to a member of the general public. The public can obtain statistical data in a form that does not identify any particular organization or practitioner.

Q: Is the information in the NPDB confidential?

A: Yes, the information in the NPDB is confidential and restricted to use only for the purposes authorized by the data bank regulations. Improper or unauthorized disclosure can result in civil monetary penalties, whether the data bank information was originally received directly or indirectly. An organization that properly receives data bank information may use that information, including disclosing it further, as part of its own professional review activities, such as medical staff appointment and clinical privileging.

By Bill Shields, JD, LLM, CAE, and Tom Hoffman, JD, CAE

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