Navigating the intricacies of the National Practitioner Data Bank (“NPDB”) can be a challenging undertaking, especially in instances where reportable incidents have occurred. The NPDB is a clearinghouse created by Congress that maintains confidential information relating to the monitoring of health care practitioners, entities, providers and suppliers. One of the most notable resources of the NPDB is the reporting division. The stated goals of the NPDB are to improve health care quality, protect the public and reduce health care fraud and abuse in the U.S. However, the practical result of a report to the NPDB is a permanent record of adverse action. A negative NPDB report can severely impact a physician’s employment prospects and eligibility for clinical privileges. When reportable incidents are recorded, it is imperative that physicians address their options immediately.
Reporting is a common tool utilized by hospitals, medical malpractice payers, state medical and dental board, DEA, OIG and healthcare entities that utilize formal peer review, to both submit reports and obtain information on reports submitted by other healthcare institutions. The eligible participating health care entities utilize the NPDB to obtain information and formulate decisions relating to licensing, certification, hiring, credentialing and contracting. Registration with the NPDB is required and has become commonplace in the health care industry. Reporting is most commonly used in the Hospital settings to submit information to the NPDB community, relating to certain adverse clinical privilege actions involving professional competence or conduct of physicians. Reports are usually submitted in response to negative actions or findings by the peer review organizations and they can have a significant impact on a physician or healthcare practitioners’ practicing privileges and career. The discretionary drafting of the report narratives is an important component of the report and carries considerable weight.
Healthcare entities report adverse conduct or adverse clinical care rendered by the practitioner. A report to the NPDB by a healthcare entity, is the preliminary step after an adverse event, and will remain outstanding until a supplemental conclusory report is submitted at the conclusion of an investigation or other action. The NPDB permanently maintains the reported information unless it is corrected or voided from the NPDB by the reporting entity or by the NPDB as a result of the Dispute Resolution process. While it is highly uncommon for reports to be removed in their entirety, supplements or reporting corrections are permitted and can reduce the severity of the negative impact reporting causes. Therefore, it is crucial that the practitioner seek the expertise of a healthcare attorney to ensure their interests are best protected. Follow us for the next part of this series on the NPDB and its impact on providers.
Frier Levitt has extensive experience representing physicians and healthcare providers in a variety of matters, including NPDB reporting challenges, suspension and termination of privileges, and negotiating with healthcare entities to resolve adverse actions. Our main goal in assisting reported practitioners is to facilitate resolutions with the healthcare entities. Contact us today to learn more about how to properly navigate and mitigate the impacts of NPDB reporting.
