National Practitioner Data Bank

The National Practitioner Data Bank (NPDB)

The National Practitioner Data Bank (NPDB) was established by the passage of the Health Care Quality Improvement Act of 1986 (HCQIA), which directed the Secretary of Health and Human Services (HHS) to set up a system to collect and release information on the professional competence and conduct of physicians, dentists, nurses and other health care practitioners.

The idea was to provide a central, national depository of any negative information about the competence and professional performance of health care providers to act as a “red flag” for others’ consideration. Congress was concerned that healthcare professionals and physicians in particular who were disciplined in one state or arena could freely move to another state or locale and start anew despite a history of bad professional performance.

» Read about Summary Suspensions

The Health Insurance Portability Data Base (HIPDB)

The Health Insurance Portability and Accountability Act of 1996 led to the creation of the HIPDB to combat fraud and abuse in health insurance and health care delivery. This databank is managed by the Healthcare Resources and Services Administration (HRSA) of the Department of Health and Human Services (DHHS).

The HIPDB is a tracking system to alert users that a comprehensive review of the practitioner, provider, or supplier’s past actions may be prudent. HIPDB information is to be used in combination with information from other sources in making determinations on employment, affiliation, certification, or licensure decisions.

The information reported to the National Practitioner Data Bank (NPDB) primarily comes from three sources:

• Malpractice judgments and settlements (no matter how small) must be reported by insurance companies
• Disciplinary actions that affect a practitioner’s clinical privileges or professional membership status, especially those implicating patient care, must be reported by hospitals and professional societies
• State licensing boards must report restrictions, including suspension and revocation actions, imposed on a practitioner’s license

This means that adverse actions against a physician, dentist, nurse or other health care professional that stem from a professional review, disciplinary action or licensure proceeding will be reported to the NPDB.

Beginning in March 2010, state licensing agencies are also now required to report certain actions taken against some non-physician and non-dentist healthcare providers to the NPDB, not only the HIPDB, thereby widening the scope of those able to access reportable events.

The NPDB is required to make this information available to hospitals, state licensure boards, select professional societies and other health-care entities under certain circumstances. Demands are increasing for this information to be made available to the public. Similar information may be available upon written request through the state licensing boards, and now many licensing boards release some of this data through their web sites.

That is why it is so important that you try to avoid a report to the NPDB and ensure that the information contained in any report is accurate and not misleading. Contact Frances Cullen to help you assess the risks and consequences of an adverse action affecting your medical license and/or hospital status, and events that could lead to such actions, to thereby limit its potential impact on the NPDB.

NPDB officials rely on practitioner notification and dispute resolution proceedings to ensure the accuracy of reports, but it is notoriously difficult to obtain corrections to data bank information. Prior to any action that could result in a report or prior to an entity’s reporting to the NPDB, you should seek to limit damaging information that might be contained in the report.  

If you disagree with the information contained within an NPDB report, you need to take immediate action to dispute any controversial information.  Failing that, you should carefully word your response statement, which will also be included as part of the report. Contact Frances Cullen for assistance in correcting inaccurate or misleading data in a NPDB report that could destroy or injure your medical career.

Representative Cases

In a case where a hospital summarily suspended a physician’s clinical privileges, Frances Cullen worked with the hospital to address what they perceived as alleged deficiencies and helped the physician obtain a “void” to remove the negative National Practitioner Data Bank (NPDB) report that would have had a significantly negative impact on his career.

In another hospital peer review case, Frances Cullen worked with a hospital, who imposed a temporary limitation on a physician’s clinical privileges to limit the language of the National Practitioner Data Bank (NPDB) language and its potential negative effect.

Frances Cullen, PC has worked with numerous physicians and dentists in providing sound advice in response to potential claims for settlement to avoid a report to the National Practitioner Data Bank (NPDB).

Similarly, Frances Cullen, PC has advised several physicians and other healthcare professionals on whether to submit applications for licensure, or to pursue hospital credentialing and licensure in other states where there existed the potential for a “negative” NPDB report.

Contact Frances Cullen, PC

Contact Frances Cullen as soon as possible if you are a physician or other healthcare provider and you suspect you may be facing a potential reportable event to the National Practitioner Data Bank (NPDB) and the Health Insurance Portability Data Base (HIPDB).

Don’t risk your license and your livelihood, and settle for any lawyer when you can call Frances Cullen, PC to retain an attorney experienced in this specialized area.

Proviso: Due to the professional stature of my clients and the sensitive nature of the issues that are the subject of these matters, client names are not provided for these cases.