REPORTING REQUIREMENTS: THE NATIONAL PRACTITIONER DATA BANK
By: Amy L. Garland
The National Practitioner Data Bank is an electronic repository of all payments made on behalf of physicians in connection with medical liability settlements or judgments, as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other health care practitioners. The NPDB was established by Congress as part of The Healthcare Quality Improvement Act of 1986. By federal law, information on all medical liability payments and on certain adverse actions must be reported to the NPDB. In turn, the NPDB is required to make this information available to hospitals, state licensure boards, some professional societies and other health care entities under certain circumstances. It is primarily an alert or flagging system which is intended to put parties on notice that the physician may have competence or professional misconduct problems. The information is considered confidential and is released only to the eligible entities or to physicians and other health care practitioners who wish to conduct a self-query.
The NPDB collects and disseminates information, such as professional liability payments made on behalf of a physician or other health care practitioners. Adverse action reports are based on professional conduct that adversely affects privileges for more than 30 days, such as reducing, restricting, suspending, revoking or denying privileges. The NPDB also collects and disseminates information when there is a voluntary surrender of license or restriction of privileges while under investigation or in lieu of an investigation. Any voluntary surrender related to retirement, nonpayment of licensure renewal fees or changes to inactive status, if there is not an investigation in progress, are not reportable. Any disciplinary actions related to competence or professional misconduct are reportable, as are professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the society. Finally, Medicare and Medicaid exclusion reports containing sanctions against a practitioner from the Medicare or Medicaid program due to fraud and abuse are reportable. This list should not be considered exclusive.
Should you have questions regarding whether an occurrence is reportable, please refer to The National Practitioner Data Bank Guidebook.