If you're a licensed healthcare professional, you know how crucial it is to avoid being accused of medical malpractice or facing any other adverse criminal or civil charges or judgments that could result in the revocation of your healthcare or medical license. Being reported to the NPDB could have a long-term adverse effect on your career because almost all hiring firms in the healthcare industry check this registry before making recruitment decisions. To make things worse, reports in the NPDB are irreversible and can't be "expunged." If a healthcare provider has a blemish on their NPDB record because of disciplinary measures taken against them by their licensing board, they can never practice again.

Understanding the National Practitioner Data Bank

The National Practitioner Data Bank (NPDB) is a secure online database of records documenting medical malpractice payouts and some other wrongdoings involving healthcare practitioners, such as state and federal licensure and certification proceedings, as well as any adverse actions involving clinical privileges at a medical facility.

Congress established the NPDB in 1986 with the primary objectives of enhancing healthcare quality, safeguarding the public, and minimizing healthcare abuse and fraud by trying to stop healthcare practitioners and other organizations from relocating from one state to another without declaring prior infractions linked to incompetence and detrimental performance.

In May 2013, the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB) amalgamated to form a single database for health regulatory purposes. The National Practitioner Data Bank (NPDB) is not usually accessible to the general public but registered healthcare organizations that comply with certain federal standards can access the NPDB. This list of organizations is rather extensive and includes institutions that manage employment, physician privileging, or professional review.

State licensing agencies, federal and state law enforcement agencies, hospitals or healthcare facilities credentialing personnel, specialty boards, professional societies, and all third parties who deal with providers are some organizations that are allowed access to NPDB reports. Most of the bodies mentioned above, as well as institutions that provide medical malpractice payouts, criminal prosecutors, the OIG, the DEA, and private accreditation bodies, are allowed to register their reports on the NPDB.

In other words, an NPDB report would be issued whenever a medical practitioner is subjected to a formal peer evaluation process that leads to disciplinary measures or penalties. Any disciplinary action imposed by an organization that permits a peer evaluation process, irrespective of whether it takes the form of penalties, fines, reprimands, suspensions, revocations, or any limitations or practice restrictions, would be recorded. Therefore, the NPDB has become an indispensable resource for credentialing, recruiting, and terminating medical professionals.

Mandatory NPDB Reporting

Healthcare facilities should only disclose measures taken against medical professionals violating their clinical privileges. However, they are also allowed to report such actions when they happen to other medical practitioners.

The following information should be reported to the NPDB by licensing bodies, health insurance, malpractice payers, and medical organizations:

  • Payments for medical malpractice
  • State and federal licensing and certification procedures
  • Actions that affect clinical privileges
  • Professional society membership acts that are detrimental
  • Negative acts or results found by peer review and private accreditation agencies
  • Criminal and civil cases involving the healthcare industry
  • Exclusions from taking part in a state or federal healthcare program
  • Other adjudicated acts or decisions

Failing to report any issue automatically leads to further Title IV penalties, including the following:

  • Malpractice payers who fail to report their medical malpractice payments can be fined no more than $23,331 per payment
  • The Secretary of HHS has the authority to take away the reporting obligation from state dental or medical boards that don't submit reports of unfavorable actions
  • Hospitals and other healthcare providers who fail to disclose adverse outcomes risk having their names listed in the Federal Register as well as losing their Title IV immunity with regards to professional assessment activities for three years, starting on the 30th day from publication
  • Professional medical societies could lose their immunity privileges under Title IV for three years if they don't report unfavorable membership actions
  • Health plans that fail to submit adverse actions needed to be notified to the NPDB face civil penalties of no more than $39,811 for each activity that is not reported
  • Finally, any federal agency that fails to record adverse actions in accordance with the law is listed in the public report published by the Secretary of HHS

Types of Actions That Can Be Reported to the NPDB

Both civil and criminal actions should be reported to the National Practitioner Data Bank (NPDB) within thirty calendar days after their execution:

State and Federal Criminal Actions

When a healthcare professional, supplier, or provider has been convicted of a crime that has any bearing on the provision of healthcare services, the conviction should be reported to the National Practitioner Data Bank (NPDB).

It also includes:

  • A judgment rendered against a person or institution in a state, local, or federal court, irrespective of whether an appeal is still pending or the sentence or other criminal record has been removed
  • A conviction against the person or thing in a state, local, or Federal court
  • A guilty or nolo contendere plea entered by the person or organization and acknowledged by a state, local, or Federal court
  • A situation where a person or organization has agreed to take part in a first offender program, delayed judgment, or another agreement or program that withholds the entry of conviction or a judgment
  • Injunctions relating to healthcare should also be disclosed

Civil Actions

When it comes to delivering healthcare products or services, a civil lawsuit against a healthcare professional, supplier or provider is worth reporting to the NPDB, irrespective of whether the ruling is on appeal.

For multiple-party lawsuits:

  • A federal agency should disclose the whole action and all payments made to all claimants, whether private or public, in a multi-party dispute
  • When more than one health plan claimant is involved, but a federal agency isn't a party, the health plan that received the most significant award must disclose the total actions for all involved parties

Why You Should Avoid Being Listed on the NPDB

Every physician in practice today requires a valid license to practice medicine. Several other people work as medical staff at ambulatory surgery centers, hospitals, or other healthcare institutions and are board certified in a specific field of medicine.

Most doctors have contracts with third parties as authorized providers, and some have credentials or certifications from various public or private organizations. When an institution submits a negative report to the NPDB, the record becomes visible to all of these institutions, many of which check the NPDB regularly. Any of these organizations could impose penalties or restrictions on the doctor after receiving notice of the unfavorable action, based on how serious it is.

For instance, the American Board of Psychiatry and Neurology has the authority to revoke or suspend a certified physician's diplomate status if a "condition or restriction" has been placed on their ability to practice medicine. Medical specialists in hospitals are often required to update their board certifications.

Third-party payers, including government-run programs such as Medicare, state-run health programs, and commercial payers, won't think twice about revoking a physician's provider status if the underlying unfavorable action is related to a severe problem with the quality of service or insurance fraud. Similarly, state licensing boards would punish licensees who get a citation from the licensing authorities of other states. This practice is referred to as "sister state reciprocity."

How to Avoid Being Reported to the NPDB

Winning a malpractice action is one approach to avert a report. Consequently, averting an NPDB report also pushes physicians to file claims rather than settle, despite the cost.

Another strategy to prevent an NPDB report would be to avoid/avert a lawsuit. Avoiding an NPDB report could be accomplished by having verbal conversations with patients who are angry or seeking redress as well as coming to an understanding to refund payments or cover costs (provided there are no payments made by an insurance carrier).

In addition, if a physician receives a cash payment to satisfy a payment demand, the transaction will not be reported to the NPDB. If a patient is upset, it's best to sit down and speak with them face to face. Even though money is sometimes given, patients frequently wish to be understood.

Other options for avoiding reporting to the National Practitioner Data Bank have been pursued by states enacting "Notice Laws," which need practitioners to be issued written notices before they can initiate lawsuits. The notice's goal is to persuade the physician and patient to work out a solution without filing a malpractice claim.

Similarly, some facilities and other private practices utilize contracts with their patients that require them to provide a written request for arbitration (not for payment). This initiates a procedure that may foster reconciliation between the litigants in lieu of an official demand for money or malpractice payment. Both of these could be workable alternatives to avoiding the NPDB report.

Finally, when corporations, like hospitals, face a lawsuit, they can deploy a legal defense known as a "corporate shield." Only when each specifically identified physician has been dismissed is a resolution negotiated and payment provided. No report is filed for the physicians involved since the settlement solely consists of the institution.

Additionally, a practitioner needs to make sure that no personal information about them is contained in any judgments or settlement agreements when a lawsuit against them has been dismissed.

There are several methods for avoiding filing a report in the NPDB, making it difficult to verify the reliability of the database's information. It is crucial to consult with a lawyer to provide clarifying remarks in the event of a report.

For instance, a doctor involved in an incident that results in a lawsuit, staff privilege restrictions, and license revocation will have many reports, even though they are all related to the same event. The doctor has some negotiating power over how these reports are worded.

Finally, be cautious about the documents you sign. With regard to malpractice, physicians and employers have opposing interests. Steer clear of contracts that let an employer resolve a lawsuit without needing a physician's approval, and always get legal advice before signing anything. Every doctor should want to avoid malpractice claims, but if they do arise, it's critical to know your legal rights.

How to Respond if You're Reported to the National Practitioner Data Bank

A physician's NPDB report will stay on the National Practitioner Data Bank website for as long as the physician continues to practice. A physician subject to a report will be alerted when the organization submits the report. There are numerous options available at that point.

The physician can include a response statement that is no longer than 400 words long if all they wish to do is provide their own account of what transpired or clarification about the report. That statement is included in the National Practitioner Data Bank report.

If a practitioner questions the authenticity of the information, he or she must get in touch with the reporting organization and make an effort to settle the issue immediately. When a report is contested, the healthcare provider that submitted it can make changes, withdraw it, or leave it as is.

If, after sixty days, the practitioner has not received a reply from the organization or is dissatisfied with the answer they have gotten, they have the option to escalate the matter to the Dispute Resolution stage, that's a more prolonged and extensive process that involves the hiring of a dispute settlement mediator.

Every practitioner is required to take reasonable precautions to make sure that any resolution, settlement, plea deal, or consent agreement that they enter into with any administrative, regulatory, criminal, law enforcement, or civil entity does not end up as the focus of a National Practitioner Data Bank report.

Suppose it's impossible to avoid disclosing the unfavorable action to the database. In that case, the next best approach is to collaborate with the organization to constrain the information that will be included in the report.

How the NPDB Listing Can Affect Your Career

The following licensed healthcare professionals are reportable to the NPDB:

  • Chiropractors
  • Dieticians
  • Dentistry professionals
  • Eye & vision specialists
  • Emergency medical services personnel
  • Nurses' aides
  • Nurses
  • Pharmacy technicians
  • Pharmacists
  • Psychologists
  • Both physicians and their assistants
  • Podiatrists
  • Rehabilitation providers
  • Social workers
  • Restorative practitioners
  • Respiratory specialists
  • Technologists
  • Hearing, speech, and language specialists

The National Practitioner Data Bank (NPDB) is often queried by state agencies that license healthcare providers (in addition to state medical panel of examiners) to verify the provider license renewals. Also, healthcare companies frequently use this database before making decisions regarding staffing and hiring.

The SSA sections 1921 and 1128E mandate that state licensing boards notify the NPDB of some measures taken against physicians, organizations, suppliers, or providers.

State licensing actions that result in revocation or suspension of a license also requires reporting to the National Practitioner Data Bank if they meet all three of the following criteria:

  • Medical professionals were subjected to adverse actions
  • Adverse measures that follow official proceedings
  • Adverse actions accessible to the general public

For instance, a Board of Nursing's adverse action can consist of the following:

  • License revocation or suspension
  • Reprimand
  • Censure
  • Probation
  • Formal proceedings that are dropped or brought to a close since the nurse gave up their license or moved out of state
  • Any other circumstance in which the practitioner's license is revoked or loses the ability to apply or renew their license (whether it be by voluntary surrender, the rule of law, nonrenewal (except nonrenewals because of fee nonpayments, transition to inactive status, or retirement), or otherwise)

The NPDB is accessible to many organizations (professional, hiring, and licensing) for the purpose of obtaining information about healthcare providers who have been penalized by their respective state licensing boards:

  • Healthcare facilities, including hospitals
  • Organizations that focus on quality improvement
  • Professional organizations that conduct formal peer reviews
  • Organizations in charge of overseeing federal healthcare initiatives, including contracted private companies
  • State agencies that provide licenses and certificates
  • Health plans
  • Federal certification and licensing organizations
  • Medicaid fraud prevention organizations
  • State entities in charge of managing or overseeing the management of the state's healthcare initiatives
  • State-level law enforcement organizations
  • Practitioners, entities, service providers, and vendors
  • Federal law enforcement personnel and organizations
  • Researchers (statistical data and deidentified only)

Federal regulations require only hospitals to conduct NPDB searches when doctors, dentists, or other healthcare professionals apply for professional privileges or medical staff appointments, in addition to every 2 years after that.

However, because most Health Centers like to disclose clinical privileges proceedings conducted against other categories of practitioners, including nurses, they frequently search the NPDB when making decisions on hiring to assess a larger spectrum of healthcare professionals.

The NPDB reports are permanent. Unless the material is amended or deleted from the database by the entity that reported it or by the National Practitioner Data Bank as a consequence of the Dispute Settlement procedure, information disclosed is kept there indefinitely. Any healthcare professional subjected to unfavorable actions must be reported by reporting bodies, including medical malpractice insurers.

Although a state's expungement of conduct erases it from the practitioner's public records, the NPDB doesn't recognize the state expungements. Consequently, an expungement at the state level is not a justification for nullifying the NPDB findings. Avoiding disciplinary action from a state licensing board is the only foolproof way to keep from being reported to the NPDB.

Find a Long Beach Professional Healthcare License Defense Law Firm Near Me

Suppose you're a healthcare professional being investigated for a licensing infringement or have a criminal record and wish to apply for a professional license. In that case, you can contact The Legal Guardian right away. We can help you take the necessary steps to prevent being reported and listed on the NPDB. Call us at 866-448-6811 today.