Navigating the National Practitioners Data Bank (“NPDB”) Series: Part IV – Subject Statements & Introduction to the Dispute Process

Reporting to the National Practitioner Data Bank (“NPDB”) is required when certain adverse clinical privilege actions involving professional competence or conduct of physicians occur. Reports submitted in response to negative actions or findings by an organization’s peer review committee can have a significant and permanent impact on a physician or healthcare practitioner’s (“Subject”) practicing privileges and career. Subject individuals of NPDB reports are permitted to dispute the report in its entirety or submit responsive narratives enumerating their position on the reported matter. A Dispute Report may be submitted if the subject disagrees with either the factual accuracy of the report or whether the report was submitted in accordance with NPDB reporting requirements, including the eligibility of the entity to report the information to the NPDB. Once the report has been submitted into Dispute Status, the subject may: (1) take no additional action and have the report remain in the NPDB with a dispute notation; (2) withdraw the report from Dispute Status and the dispute notation will be removed from the report; or (3) request that the report be elevated to Dispute Resolution – which must meet certain prerequisites.  Alternatively, if the subject decides to submit an optional subject statement, it is crucial that the statement be carefully drafted due to the imperative nature of the incident report. Contrary to a dispute report, the responsive statement allows the Subject to explain certain facts that they believe to be important, so that an individual or entity reviewing the NPDB report has a complete understanding of the incident at issue. It is recommended that should a practitioner decide to submit a statement, counsel be sought to assist in the composition of such.

As discussed in Part I of this article series, a report to the NPDB by a healthcare entity is the preliminary step taken after an adverse event occurs. Hospitals have sole discretion in determining the contents and format of the report, which includes details relating to the adverse incident and result of the peer review determination. When a report is submitted, the NPDB processes the report and notifies the Subject. The initial incident report 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.

Report Subjects are entitled to add a Subject Statement to the NPDB report, which becomes part of the permanent report unless subsequently edited or removed by the Subject. When a Subject Statement is submitted, the statement is sent to the reporting entity, is included in future queries submitted to the NPDB and is sent to all queriers who received a copy of the report within the past 3 years. The NPDB reviews all reports to ensure their accuracy, however any amendment or correction to a report may only be submitted by the reporting entity. Alternatively, the Subject is permitted to dispute the report in its entirety.

Report Subjects are permitted to refute either the factual accuracy of the report and/or whether the report was submitted in accordance with NPDB reporting requirements through the NPDB dispute process. Subjects must preliminarily attempt to contact the reporting entity to resolve issues raised by the report, prior to engaging in the NPDB Dispute Resolution. A request to enter into Dispute Status is required in order to pursue the Dispute Resolution by the NPDB, and until efforts are verified and proof of lack of success are provided, Subjects are not permitted to dispute reports.

When a report is submitted to the NPDB, it is crucial that the practitioner seeks the expertise of a healthcare attorney to ensure their interests are best protected. While report supplements and reporting corrections are permitted, and often aid in minimizing the negative impact reporting causes, it is extremely uncommon for reports to be removed in their entirety. Therefore, mitigating the impact of reports as soon as they occur is paramount to protecting a physician’s reputation and career.

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 to learn more about how to properly navigate and mitigate the impacts of NPDB reporting.