The National Practitioner Data Bank (NPDB) was introduced by Congress in order to improve the quality of medical care and to limit the ability of practitioners with a troublesome past from moving from state to state and billing government health care programs. The regulations that govern NPDB were implemented as a result of the Health Care Quality Improvement Act of 1983. 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.
The main reporting entities that affect most health care professionals are insurance carriers as well as anyone who makes an indemnity payment on behalf of the health care provider, hospitals or healthcare employers and also state licensing boards.
With respect to insurance indemnity payments, the general rule is any type of payment made on your behalf to release you from a lawsuit is reportable. In the past, physicians were released and the hospital or corporation would assume liability to avoid reporting. This practice is no longer allowed and the payor needs to report the payment to the NPDB no matter the amount.
When a health care practitioner faces disciplinary action from their state licensing board, summary/emergency suspension of their license or action taken by a credentialing body, a report needs to be provided to the NPDB within 15 days. Therefore, it is important to understand that when a health care practitioner is dealing with a licensing or credentialing issue they must contact an experienced health law attorney. A health law attorney can work with you in order to limit or reduce the discipline, which results in no reporting or even a more positive report to the NPDB.
Negative information on the NPDB has the ability to substantially harm a health care practitioner’s career. A practitioner with just one negative report can easily find it difficult to gain or maintain staff privileges, become omitted from billing large insurance companies and Medicare and face future state licensing actions.
Reports to NPDB are permanent but may be appealed through a dispute process. Initial NPDB disputes must be taken up with the reporting entity. If the reporting entity fails to adjust the report after a request, the subject may ask for review of the report by the Secretary of HHS. The Secretary reviews reports only with regard accuracy of the factual information and also to ensure that the information was required to be reported. NPDB’s dispute review process is highly technical and requires the knowledge and skill of an experienced health law attorney. Practitioners must be cautioned from filing disputes by themselves with the Secretary of HHS because once an initial dispute is filed, the subject is not likely to be granted a second review. There is no formal NPDB appeals process for reconsideration of the Secretary’s review.
If you have received or perhaps are about to receive a negative NPDB report and wish to appeal, you should contact Delegal & Poindexter. We can fight to prevent damaging information from being placed on the NPDB and protect your rights during the appeals process.