The NPDB is the Death Knell for a Medical Career
Physician Lawyer Daniel Horowitz Can Help !
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If you have been unfairly reported to the National Practitioner Data Bank – We Can Often Help !
What is the National Practitioner Data Bank?
The National Practitioner Data Bank (NPDB) is a nationwide central database which publishes information about adverse actions taken against physicians, from medical malpractice payments to licensure and clinical privileges actions. Peer review suspensions are a main trigger of reporting.
Health care entities are required to file an NPDB report for any reportable adverse action, and these reports are kept in a permanent record which is available to registered healthcare entities upon request.
Who can view my NPDB report?
Information reported to the NPDB is confidential and is not available to the general public. However, NPDB reports are accessible to registered healthcare organizations, as specified in the NPDB statutes (Title IV, Section 1921, and Section 1128E) and implementing federal regulations (45 CFR Part 60). This includes:
- Hospitals and other health care entities
- State boards
- Licensing agencies
- Medical groups
- Medical malpractice payers
In fact, hospitals are required to query the NPDB every two years for reports on all physicians, dentists, and other health care practitioners who hold clinical privileges at the hospital or are on its medical staff. Hospitals are the only entity with this federal requirement, but other entities can and will request a physician’s file when making licensing, hiring, and credentialing decisions.
What Actions are Reportable to the NPDB?
Registered healthcare entities are required by law to file a report within 30 days of an adverse action, including:
- Medical malpractice payments
- Adverse clinical privileges actions
- Adverse professional society membership actions
- State and federal licensure and certification actions, including probation or loss of license
- Negative actions or findings by a peer review organization
- Negative actions or findings by a private accreditation organization
- Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid)
- Other adjudicated actions or decisions
- Health care-related civil judgments and criminal convictions in Federal or state court
What is and isn’t reportable to the NPDB is not always black and white.
Furthermore, a physician may not always be aware that they are taking a reportable action. A hospital is not required to tell a physician when they are under investigation. However, resigning while under investigation is reportable to the NPDB.
It is important for a physician to be familiar with what actions are reportable to the NPDB, so they can avoid such actions. Click Here for the NPDB website discussing what must be reported.
But they PROMISED Not to Report Me !!!
A promise made verbally is not worth that much. Here are the penalties for NOT reporting. Consider that sometimes you may receive a promise but later a medical lawyer reads the riot act to the person with whom you “made a deal”. Consider the sanctions for failing to report to the NPDB. Good intentions and “promises” are often abandoned in light of self interest.
Sanctions for Failing to Report to the NPDB
- Any malpractice payer that fails to report medical malpractice payments is subject to a civil money penalty of up to $23,331 for each such payment involved.
- Any hospital or other health care entity that fails substantially to report adverse actions will have its name published in the Federal Register, and the organization will lose its immunity from liability under Title IV with respect to professional review activities for a period of 3 years, commencing 30 days from the date of publication in the Federal Register.
- Any State Medical or Dental Board that fails to submit reports of adverse actions can have the responsibility to report removed by the Secretary of HHS.
- Any professional society that fails substantially to report adverse membership actions can lose immunity protections provided under Title IV for 3 years.
- Any health plan that fails to report information on an adverse action required to be reported to the NPDB shall be subject to a civil money penalty of up to $39,811 for each adverse action not reported.
- The Secretary of HHS shall publish a public report that identifies those government agencies that have failed to report information on adverse actions as required.(Source NPDB Website)
A NPDB report was filed against me… what can I do?
Can I contest an NPDB report?
There is a dispute process that can be taken if you believe you have been wrongly reported to the NPDB.
It can be very difficult to get a NPDB report removed, however there are measures you can take to mitigate the effects of a NPDB report beforehand, such as negotiating the wording of the report with the reporting entity.
Can I view my NPDB Record?
Yes, a physician can request a copy of their NPDB report.
For more information about the NPDB database, visit www.npdb.hrsa.gov.