As with most legislation enacted with the purpose of making things safer for consumers, the intentions behind the creation of the National Practitioner Data Bank (NPDB) are noble. However, there have been unforeseen complications that continue to unreasonably and adversely affect health care providers because of the NPDB. As such, many health care practitioners are being forced to seek redress through legal means to fix National Practitioner Data Bank errors.
In 1986, Congress passed the Health Care Quality Improvement Act, or HCQIA. Among other reasons, this sweeping piece of legislation was enacted to help states combat the problem of doctors fleeing from malpractice inquiries, civil litigation and/or license forfeiture in one state by moving to another and continuing to practice. This
Specifically, Title IV of the HCQIA calls for the creation of a national database that “tracks information on medical malpractice payments and adverse actions related to licensure, clinical privileges, and professional society memberships of physicians, dentists, and, in some other cases, other health care practitioners.” This is the origin of the NPDB.
How does the National Practitioner Data Bank gather its data?
By the terms outlined in Title IV, anyone defined by the law as a reporting entity is required by law to submit reports to the NPDB. Currently, the NPDB stores more than 1.25m reports on medical professionals and each month more than 6700 new reports are added.
What are some of the entities subject to compulsory reporting?
This is by no means a comprehensive list, but the most common reporters are as follows:
- Health plans
- State boards
- Licensing agencies
- Medical malpractice insurers
What’s in the National Practitioner Data Bank?
There are three main data points tracked within the NPDB:
- Adverse Action Reports (AARs): This category encompasses any instance of licensing, certification, or clinical privileges revoked or suspended by state or federal entities.
- Medical Malpractice Payment Reports (MMPRs): If a malpractice claim is paid out on behalf of the practitioner, it will be recorded here.
- Judgment or Conviction Reports (JOCRs): Here listed are any civil judgments or criminal convictions taken at the state or federal level against the practitioner.
Who can view data found in the National Practitioner Data Bank?
The data contained within the NPDB is confidential and is not available to the public. The entities that can view data in the NPDB mirror the list of mandatory reporters. In this case, the entities use the database to search for records on a potential hire or to do due diligence before offering access to health care facilities.
What happens if the data contained within the NPDB is disputed or inaccurate?
As the data contained within the NPDB is intended to help entities hire and perform due diligence on medical professionals they may be considering for hire, a negative report on a practitioner’s profile may serve to exclude him or her from consideration for a job. In this way, a negative result can adversely affect the financial prospects for the provider in question.
But there are instances where inaccurate, outdated, or even falsified reports have been added to the NPDB.
Practitioners are notified of any report that is added to their record. It’s very important to carefully review any report that is added for accuracy. If a report has been filed, the physician may add a Subject Statement to the report giving their version of events. This stays with the report and may give sufficient cause for a searcher to overlook or accept the practitioner’s account of the incident.
Disputing National Practitioner Data Bank reports
If the subject disputes the accuracy of the report, and the Subject Statement does not sufficiently remedy the issue, he or she may choose to dispute some or all of the information contained within through the formal dispute process.
Once the report has been elevated to Dispute Status, the subject of the report has 60 days to contact the reporting entity and resolve the issue. If this effort is unsuccessful, the report goes into Dispute Resolution and may ultimately be categorized thusly:
- Accurate as submitted: Data in report is upheld to be accurate.
- Inaccurate as submitted: Data in report is not accurate and report is modified or removed.
- Outside the scope of Dispute Resolution: A note is added to the report specifying this outcome and the Dispute is removed from the report.
What if the Dispute Process fails to solve your issue?
If, after completing all the necessary steps within the dispute process, a subject still finds that his reports are unfairly stigmatizing his reputation, he may seek legal remedy. Keep in mind that the law protects reporters from civil penalty in cases of good faith.
If you find your name is on a physician defamation list found on the NPDB, the law firm of Bochetto & Lentz, P.C. can help you clear your good name. We are your go-to data bank error lawyers in the Philadelphia area.