The National Practitioner Data Bank: What Every Physician Needs to Know

You were sued. The litigation process took its course, and now you have settled with the plaintiff or a jury has rendered a verdict against you. Unfortunately, this means the facts of the case and settlement or verdict will be reported to the National Practitioner Data Bank (NPDB). So what does this mean?

What is the National Practitioner Data Bank?

The NPDB was created as part of the Health Care Quality Improvement Act of 1986. Congress’ intent in enacting the law was to improve health care quality by encouraging reporting of “unprofessional behavior,” thereby restricting the ability of reported physicians to move from state to state without disclosure of previous medical malpractice payments or other adverse actions, such as license suspensions or revocations or denials of privileges.

Who gets reported?

Physicians, dentists and other licensed health care practitioners, including professional counselors (mental health, substance abuse, alcohol and family), dental assistants and hygienists, dietitians and nutritionists, EMTs, nurses — including registered nurses, nurse midwives and nurse practitioners — eye care providers (optometrists, opticians), pharmacists, physician assistants, podiatrists, psychologists, social workers, rehabilitation therapists, respiratory therapists, occupational therapists, and speech pathologists.

What information must 
be reported?

  • settlements, judgments or other payments made “in satisfaction in whole or in part, of a claim or judgment ...”1 (However, the NPDB specifically notes that medical malpractice settlements will not be construed as a presumption that malpractice occurred.) Money payments are reportable whether the payment is $1 or $1 million.
  • adverse actions affecting a physician’s or a dentist’s clinical privileges for more than 30 days; or when a physician or dentist surrenders his/her privileges while being investigated for improper professional conduct
  • adverse licensure actions, including revocation, suspension, censure, reprimand, probation or surrender (Reinstatement of a license is also a reportable event.)
  • adverse professional society membership occurrences relating to professional competence

The information reported to the NPDB is confidential, although it may be disclosed pursuant to an entity carrying out a professional review activity, such as a hospital reviewing a physician’s application for privileges or staff appointment.

Who is required to report?

Medical malpractice insurers making payments, state health care licensing authorities, hospitals, HMOs, group practices, professional societies with formal peer review, state entity licensing authorities and other peer review organizations. When a report is submitted, the subject of the report is notified.

Who can access the information?

Some entities and people who may access information include hospitals, other health care entities with a formal peer review process, professional societies with formal peer review, insurers, state health care practitioner licensing authorities, agencies administering federal health care programs, state agencies administering state health care programs, Medicaid Fraud Control Units, the U.S. Attorney General, the U.S. Comptroller General and health care practitioners, who may self-query. The general public may not access this information.

What can you do about it?

Two actions may be taken. First, every physician, dentist or other health care practitioner who is the subject of a report has the right to submit a “subject statement” and may add explanations or dispute the factual accuracy of the report. The statements are limited to 4,000 characters, including punctuation and spaces.

To submit a subject statement, go to the NPDB’s website,, and click the “How to Get Started” link under the “Practitioners” banner on the right hand side of the page. Then, click “Responding to Reports” and follow the prompts to submit a statement.

You may also dispute either: (i) the factual accuracy of the report, or (ii) whether the report was submitted in accordance with NPDB guidelines. You may not, however, dispute a report to take issue with your insurance company’s decision to settle. If the reporting entity changes the report, the dispute notation is removed, and if you believe the report is still inaccurate, you must file another dispute.

Kenneth R. Larywon is a senior partner, and Stewart G. Milch a partner, in the firm of Martin Clearwater & Bell LLP.

Source: MD News, NY - Long Island Market, Sept 2012



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