Understanding the National Practitioner Data Bank
Legally Speaking
Clifford Warren Lober, MD, JD, presents legal dilemmas in dermatology every other month. He is a dermatologist in practice in Florida and a partner in the law firm Lober, Brown, and Lober.
By Clifford Warren Lober, MD, JD, February 1, 2018
Anita: I recently spoke with a colleague who told me he was reported to the National Practitioner Data Bank (NPDB). What is the NPDB?
Bryan: The NPDB is a repository for reports of adverse incidents concerning medical providers. It was implemented in 1990 to prevent practitioners from moving from state to state without revealing prior disciplinary, malpractice, and other adverse incidents.
Anita: What is in the NPDB?
Bryan: In addition to containing over 431,000 reported medical malpractice payments, the database contains over 877,000 reports of adverse actions taken by state licensing boards and certification authorities, as well as over 31,000 reported federal and state civil judgments and criminal convictions. It receives over 640,000 inquiries each month!
Anita: Does the Data Bank only contain information on physicians?
Bryan: No, Anita. In addition to reports on MDs and DOs, the Data Bank contains information on nurses, dentists, and other practitioners.
Anita: Can anyone access the information in the NPDB?
Bryan: Only certain entities are entitled to access the reports. The information an entity can access is based upon its eligibility under each of three separate federal statutes. Those entitled to access some or all of the information in the Data Bank include hospitals, state licensing agencies, certain health care entities, and professional societies that follow a formal peer-review process. Only hospitals when granting privileges to providers, however, are required to access the database.
Anita: Can I access the NPDB to review any reports on myself?
Bryan: Yes. Upon payment of a nominal fee ($4.00), you can access the database and review any reports concerning yourself.
Anita: What if there is something in the database that I don’t agree with?
Bryan: You are allowed to append a comment to any unfavorable report and that comment will be available to any entity accessing the unfavorable report.
Anita: Who is required to report incidents to NPDB?
Bryan: Entities required to report adverse incidents include medical malpractice payers, hospitals, health plans, peer review organizations, state and federal law enforcement agencies, the Drug Enforcement Administration, and state medical boards.
Anita: You mentioned that the NPDB contains medical malpractice payment reports. Are all such payments reportable?
Bryan: No. Individuals are not required to report payments that they make using their own personal funds. However, if a corporate entity owned by a solo practitioner makes a payment on behalf of that practitioner, the payment is then reportable.
Anita: I thought all medical malpractice payments were reportable!
Bryan: Actually, that was the case until 1993 when the U.S. Court of Appeals for the District of Columbia ruled that a person making a payment for his or her own benefit was not an “entity” as required by the governing statutes.
Anita: What if a patient is willing to overlook an adverse incident if the physician does not charge for the procedure?
Bryan: If a patient is willing to accept waiver of your fee as settlement of an adverse incident, the waiver is not reportable to the NPDB.
Anita: If the patient verbally requests a refund of fees and the practitioner elects to do so, is that reportable?
Bryan: No. Only written demands for compensation or payment are reportable. Oral requests are not reportable to the Data Bank.
Anita: Is there any minimum amount below which reporting is not mandated?
Bryan: No, all payments made in response to a written demand for monetary compensation must be reported regardless of the amount except in those circumstances I previously mentioned.
Anita: Is the information in the NPDB available to plaintiff attorneys?
Bryan: No, unless the attorney has filed a claim against a hospital and can prove that the hospital failed to query the NPDB as required. Even then, the information obtained can only be used in a claim against the hospital, not against the practitioner.
Anita: I really appreciate that information. Thanks, Bryan!
