The National Practitioner Data Bank (NPDB)

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.

National Practitioner Data Bank Reports

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.

In 2013, HRSA announced that it was focusing on:

1. Behavioral health professionals

2. Chiropractors

3. Dentists

4. Nurses

5. Optometrists

6. Pharmacists

7. Physical therapists

8. Physician assistants

9. Physicians

10. Podiatrists

11. Psychologists

12. Social workers

The National Practitioner Data Bank reporting entities are:

• State medical and dental boards

• Hospitals and health care entities

• Professional societies

• Medical malpractice payors

• Health care practitioners

• Office of Inspector General (OIG), HHS

The main reporting entities that affect most health care professionals are insurance carriers and state licensing boards.

The general rule is you may report any payment made on your behalf to release you from a lawsuit. The payor must report the payment to the NPDB regardless of the amount.

There are potential workarounds prior to payment. Make sure to reach out to us if you find yourself in this scenario.

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.

National Practitioner Data Bank Appeals

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.

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 an NPDB report. If the reporting entity fails to change the report after a request, the subject may request a 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. 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 Aegis Lion Law immediately.