Understanding the National Practitioner Data Bank
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As a medical professional liability insurer, MIEC has a duty to report settlements and judgments to the National Practitioner Data Bank (NPDB) as well as to state licensing agencies, where applicable. This article will review the history and purpose of the NPDB, who reports, and what must be reported, so that we may better inform our members about this important process.
Purpose and Function
The National Practitioner Data Bank (NPDB) was established by Congress in 1986 as part of the Health Care Quality Improvement Act, and it is administered by the U.S. Department of Health and Human Services. Its mission is to maintain transparency and accountability within the healthcare system and improve healthcare quality by ensuring that information about malpractice payments and adverse actions is accessible through a national database, rather than being limited to individual state agencies.
Various health care entities are authorized and/or required to query the NPDB as part of the hiring, credentialing, or re-credentialing processes; entities are also required to report medical malpractice payments and certain adverse actions to the NPDB.
Reporting Entities
Entities that must report to the NPDB include:
- Medical malpractice insurers
- State licensing boards
- Professional societies
- Department of Drug Enforcement
- Hospitals
- Other healthcare entities, such as nursing homes
- Medical practices and solo physician practices (see note below)
- Federal agencies, including the Department of Veterans Affairs and the Department of Defense
*Note- Individuals are not required to report to the NPDB payments they make for their own benefit. Thus, if a practitioner or other individual makes a medical malpractice payment out of personal funds, the payment should not be reported. However, a professional corporation or other entity composed of a sole practitioner that makes a payment for the benefit of a named practitioner must report that payment to the NPDB.
Information Reported to the NPDB
Information that must be reported to the NPDB includes, but is not limited to, the following:
- State licensure actions
- Medical malpractice payments: For a medical malpractice payment to trigger mandatory reporting, there must be a written demand for payment related to medical care, an exchange of any amount of money, and a settlement release or adjudication.
- Judgments or convictions
- Suspension or revocation of privileges at a medical institution lasting more than 30 days
- Surrender of a license or privileges during an investigation by a medical entity or licensing body, even if prior to any adverse action
NPDB Reports
Importantly, NPDB reports are confidential and not available to the public. They are only accessible to the subjects of the reports and to certain “eligible entities” authorized to query the NPDB; these entities include hospitals (which are required to query) as well as other health care entities, licensing agencies, and professional societies. While MIEC is required to report to the NPDB, we are not authorized to query the NPDB.
NPDB regulations specifically state, “A payment in settlement of a medical malpractice action or claim shall not be construed as creating a presumption that medical malpractice has occurred.” Additionally, when a report is submitted to the NPDB, the practitioner is given formal notice and the opportunity to submit a “Subject Statement” to explain the circumstances of the event. This statement remains attached to the report unless removed by the subject. Subjects may dispute the factual accuracy of a report via a formal dispute process within the NPDB, but only reporting entities may correct or modify reports.
Legal Obligations and Penalties
Healthcare organizations, federal and state agencies, and medical malpractice payors are required by law to report to the NPDB. Civil money penalties for failure to report range from $27,000 to $47,000.
References
We want to be sure that our valued MIEC members are aware of how the data bank functions and that we are here to assist you. If any questions or concerns arise regarding the NPDB, please contact us at 800.227.4527 or email patientsafetyriskmgmt@miec.com.