Understanding the NPDB: Top 10 Tips

1. WHAT IS THE NATIONAL PRACTITIONER'S DATA BANK?

The NPDB is a national clearinghouse that discloses information on the professional competence/conduct of physicians, dentists, and other health care professionals.

2. WHAT IS THE PURPOSE OF THE NPDB?

It is used to inform health care organizations (such as hospitals, health plans, state licensing boards, and other health care regulatory entities) of a "reportable event." NPDB reports are used, along with other source data, when a practitioner is considered for clinical privileges, employment, affiliation, or licensure. For a practitioner, a report is a RED FLAG to be avoided.

3. IS THE NPDB PUBLICLY AVAILABLE?

No, but important entities have access. Hospitals must query the NPDB at the time a practitioner applies for clinical privileges or medical staff membership and biennially on existing medical staff. Other health care entities (health plans, professional societies, health care employers) engaging in peer review may query. State boards may query at any time, and typically do upon initial and re-licensing. Plaintiff's attorneys may make limited query. A practitioner may always perform a self-query.

4. REPORTABLE: MEDICAL MALPRACTICE PAYMENTS

Payments resulting from a written claim or judgment must be reported within 30 days by payers; settlements can possibly be structured to avoid a report with the help of malpractice counsel.

5. REPORTABLE: STATE LICENSING DISCIPLINARY ACTIONS

State licensing boards must report final disciplinary actions within 30 days if based on reasons related to the practitioner's professional competence or conduct.

6. REPORTABLE: CERTAIN PROFESSIONAL REVIEW ACTIONS

Certain actions taken by health care entities lasting more than 30 days due to professional competence or conduct that curtail or affect clinical privileges must be reported to the NPDB and the state licensing board within 15 days.

7. REPORTABLE: RESIGNATIONS DURING OR TO AVOID INVESTIGATION

Resignation or surrender of clinical privileges by a practitioner, if submitted during or to avoid an "investigation," must be reported to the NPDB within 15 days. A practitioner need not be notified of such "investigation" for a report to be triggered. CAUTION: Do not trigger a report unwittingly by resigning or failing to reapply!

8. REPORTABLE: ADVERSE ACTIONS BY PROFESSIONAL SOCIETIES

Certain actions that adversely affect membership and are taken due to professional competence or conduct must be reported to the NPDB within 15 days.

9. REPORTABLE: EXCLUSIONS FROM MEDICAID/MEDICARE AND OTHER FEDERAL PROGRAMS

HHS must report exclusions of a practitioner from such programs on a monthly basis.

10. A NPDB HIT WILL FOLLOW YOU

NPDB reports are copied to appropriate state boards. You must disclose a NPDB report, along with an explanation of the underlying events, in your professional applications for the balance of your career. Depending on the seriousness of the report, some entities may deny initial status and even question current status.