Understanding the National Practitioner Data Bank (NPDB)

What it Is – How it Works?

[By Eric A. Dover MD]

The NPDB, also known as the Data Bank, was written into HCQIA [Health Care Quality Indicators]. It is the national database for all physician reports.

Reporting Entities

Entities that are required to report physicians to this government program are:

Medical malpractice payers
State health care practitioner licensing and certification authorities
Hospitals
Other health care entities with formal peer review (HMOs, group practices, managed care organizations)
Professional societies with formal peer review
Federal and State Government agencies
Health insurance companies
The information collected by the NPDB includes:
Medical malpractice actions against a healthcare provider
Any adverse licensure actions by Medical Boards or peer review entities, including revocation, reprimand, censure, suspension, probation or dismissal or closure of any proceedings by reason of the practitioner surrendering the license or leaving the State or jurisdiction.
Adverse clinical privileging actions
Adverse professional society membership actions
Private accreditation organization negative actions or findings against health care practitioners
Criminal convictions that are health care-related
Exclusions from Federal or State health care programs
Entities that can query the NPDB include:
Hospitals, health care entities and professional societies with formal peer review
State health care practitioner licensing and certification authorities
Agencies or contractors administering Federal health care programs
State agencies administering State health care programs
State Medicaid Fraud Units
U.S. Comptroller General, U.S. Attorney General and other law enforcement
Self query by health care practitioner
Plaintiff’s attorney/pro se plaintiffs, but under limited circumstances
“Quality Improvement Organizations”
Researchers (statistical data only)
Federal and State Government agencies
Health plans
Researchers (Statistical data only)

Source: http://www.npdb.hrsa.gov/

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Physician Reportage

Once a physician is reported to the NPDB, their career, if they still have one, is dramatically changed forever. There is no expungement process to remove defamatory physician reports, whether true or not. The stain is there forever. You have the opportunity to write a rebuttal for what it’s worth. Actions reported to the National Practitioner Data Bank by one entity will most likely trigger cross investigations and actions by other entities.

Source: http://www.drlaw.com/Articles/White-Paper—The-Targeting-of-Physicians—Insigh.aspx

Assessment

It is easy to extrapolate the simplicity of destroying a physician’s career, psyche and family with the untenable protections afforded by HCQIA to those responsible for the destruction.

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About

Dr. Eric Dover is a board certified family practice and primary care physician in Portland, Oregon. He is a graduate of the University of California at Los Angeles [UCLA] School of Medicine.

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