What Reportable Actions Fall Under National Practitioner Data Bank Guidelines?

National Practitioner Data Bank ErrorsThe National Practitioner Data Bank (NPDB) is a Congressionally-mandated database of healthcare practitioner information designed to facilitate public awareness of important information about health care practitioners. It is the repository for information about medical malpractice, fraud, and abuse, and is maintained to ensure full disclosure in cases where physicians might relocate to another state to avoid local public knowledge. The information in the database is provided by hospitals, state licensing boards, state and federal agencies and professional societies among others, and is available for inquiry by the same, as well as by fraud and abuse enforcement agencies. Individuals are only able to access the information for research purposes.

National Practitioner Data Bank errors are of great concern to health care professionals, organizations, providers and suppliers, whose reputations can suffer a great deal if inaccurate information is entered into the database. The NPDB collects information on specific types of reportable events, including:

  • Medical malpractice payments
  • Federal and state licensure and certification actions
  • Adverse clinical privileges actions
  • Adverse professional society membership actions
  • Negative actions or findings by private accreditation organizations and peer review organizations
  • Health care related criminal convictions and civil judgments
  • Exclusions from participation in a federal or state health care program, including Medicare and Medicaid
  • Other adjudicated actions or decisions

It is easy to see how an incorrect report of any of these reportable actions filed by a medical malpractice payer, a medical or dental board, a hospital, peer review organization or any other entity could have a chilling effect on a health care professional’s ability to continue in practice, to obtain a new position, or to hold onto their accreditation. Fortunately, the NPDB has created a dispute process specifically to allow for corrections to be made.

If you find that you are the subject of a negative report entered in the NPDB, your first step is to enter the report into Dispute Status. You also have the option of asking the NPDB to review the report for inaccuracy through their Dispute Resolution process. Entering a report into Dispute Status does not automatically lead to a review. Only Dispute Resolution does this.

The process of Dispute Resolution is complex, but its importance cannot be underemphasized: a health care practitioner’s reputation can be destroyed forever when an error has been made. If you need assistance with the process or believe that you need to take legal action regarding an inaccurate report, we can help. Contact the attorneys at Bochetto & Lentz for more information.

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