Challenges for health care professionals reported in the National Practitioner Data Bank

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The NPDB is a federal information repository dedicated to improving health care quality, promoting patient safety, and preventing fraud and abuse.

The National Practitioner Data Bank (NPDB) is a federal information collection program, a part of the U.S. Department of Health and Human Services, designed to ensure health care consumers receive quality health care, patient safety, and are protected from fraud and abuse in the health care industry. This information kept and shared with authorized users includes negative health care professional disciplinary information, malpractice awards, loss of license or exclusion from participating in Medicare or Medicaid. The benefit of information sharing is measured in the efficiency in which the state agencies licensed to use the data bank can catch potential threats to the public, preventing health care professionals from having trouble in one state and leaving for another to start over with a clean slate. There are challenges however, when a health care professional is licensed in several states and there is an occurrence in one state and all the other states are notified, potentially triggering a chain reaction of inquiries among licensing and regulatory agencies.

Information collection and sharing is not new, but it is a more streamlined process today.

The United States Congress created the National Practitioner Data Bank with the intent to improve the quality of health care services while protecting the public from fraud and abuse. In 2010, when Congress voted to approve the Affordable Care Act, the NPDB was combined with the Healthcare Integrity and Protection Data Bank (HIPDB), which was originally established in 1996 in the Health Insurance Portability and Accountability Act (HIPAA). HIPDB was established to combat health care fraud and abuse, and served to collect and share information the way the NPDB does today.[i]

Reports to the National Practitioner Data Bank are “records of actions taken by authorized organizations regarding health care practitioners, entities, providers, and suppliers who do not meet professional standards.[ii]” An authorized report can include information concerning settlements and payment in medical malpractice cases in addition to negative action by health care organizations or state licensing boards in connection with the delivery of health care services, meaning a reprimand, loss of privileges, suspension, revocation and so forth. Medical malpractice reports are a concern of any licensed health care professional whose decision in whether to settle or continue defending against a complaint for medical malpractice due to concerns that paying a settlement will jeopardize the doctor’s status in the NPDB.

Licensure in multiple states can be a concern for health care professionals with reports on the NPDB.

If a health care professional settles a medical malpractice case, and they are licensed in multiple states, there could be state inquiries arising out of all the states in which the individual holds a medical license. It is possible that in the licensing agency, in the state where the medical malpractice case took place, is aware, investigates and elects not to discipline the health care professional. It is also possible that a neighboring state agency, also becoming aware of the malpractice cases through the NPDB, investigates and takes adverse action against the health care professional, such as suspending the individual’s license. That suspension could be the trigger for a domino-type effect in all the states in which a health care professional is licensed to practice their craft.

Health care professionals defend against claims and complaints to avoid reports on the NPDB.

Attorneys and consultants such as Michael V. Favia and the Illinois Professional Licensing Consultants work with health care professionals who face concerns about long-term impacts of actions that could damage their reputation and ability to earn income when reports are made to the NPBD. When negative information is reported through the NPDB, it can cost a health care professional significant time and money to protect their license to practice and make a living. Knowing the benefits and liabilities arising out of the NPDB is important, and health care professionals should be keenly aware of the NPDB and how it is used in the health care industry among the states.

Michael V. Favia & Associates offices are conveniently located in the Chicago Loop, Northwest side and suburban meeting locations, you can schedule a discrete meeting with an attorney at your convenience and discretion. For more about Michael V. Favia & Associates professional licensing work, please visit www.IL-Licensing.com and feel free to “Like” the firm on Facebook and “Follow” the firm on Twitter.

 

[i] National Practitioner Data Bank website, HIPDB Archive.

[ii] National Practitioner Data Bank website, Reporting to the NPDB

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