As a licensed healthcare practitioner, you likely know the potentially disastrous effect of an adverse action report in the Department of Health & Human Services' National Practitioner Data Bank (NPDB). You could lose your healthcare license, hospital privileges, healthcare employment, and right of your employer to reimbursement for your healthcare services, all because of a false, inaccurate, or out of date NPDB adverse action report. Fortunately, though, HHS regulations permit you to dispute an action report with our skilled and experienced representation. Retain the Lento Law Firm's premier Professional License Defense Team to help you dispute your potentially damning NPDB adverse action report before it ruins your reputation, relationships, and career. Call 888.535.3686 or complete this contact form now for representation by our highly qualified attorneys. Moving your NPDB adverse action report to disputed status may be all you need to preserve and protect your healthcare license, employment, and practice.
The NPDB's Faulty Design
The National Practitioner Data Bank (NPDB) is Congress' 1986 invention to protect patients and the public from impaired, unfit, incompetent, unprofessional, or otherwise unfit healthcare practitioners. In theory, the NPDB may have been a good idea. The NPDB was supposed to serve as a comprehensive clearinghouse for reliable information on licensed healthcare practitioners. State licensing boards, hospitals offering practice privileges, employers of healthcare practitioners, and health insurance plans and programs providing reimbursement should all be able to readily check on a healthcare practitioner's fitness. However, in practice, the NPDB has proven to be a disaster for any number of innocent, competent, hardworking, and valuable healthcare practitioners, for the following reasons.
Immunity for Inaccurate Adverse Action Reports
Incredibly, Congress, in its Health Care Quality Improvement Act of 1986 creating the NPDB, authorized immunity from civil liability to individuals and entities making inaccurate NPDB adverse action reports. Ordinarily, defamation liability discourages individuals from lying about a professional's honesty and competence, destroying the professional's reputation and career. However, under congressional authority, HHS regulation 45 CFR 60.22 grants immunity from civil liability to individuals and entities making inaccurate and damaging adverse action reports. Everywhere else, you'd have the right to hold a defamer accountable for your harm. But where it most counts, in the NPDB, reporters have no liability for inaccurate reports. The immunity's unfortunate message is to fire away, to your detriment.
No Review for Accuracy of Submitted Adverse Action Reports
Just as incredibly, Congress and the Department of Health & Human Services did not mandate any specific form of review and accuracy check of adverse action reports that reporters submit. Reporters simply complete the NPDB adverse action report form and file it, no questions asked. And as you've just seen, reporters have immunity from the damage that flows from inaccurate reports and from the accountability of civil defamation liability. Once again, the message is simply to fire away.
Self-Query of Adverse Action Reports for Accuracy
Again, just as incredibly, the NPDB system expects you to check and confirm the accuracy of submitted adverse action reports. HHS regulation 45 CFR 60.18, authorizes searches by a healthcare practitioner “who requests information concerning himself or herself.” NPDB officials call this action a self-query and give some guidance on how and why to make regular self-queries to catch and address inaccurate records. But the point here is that if you don't do it, no one else will. The NPDB system is lax, practically inviting errors.
Too Many Mandated NPDB Adverse Action Reports
Congress and the Department of Health & Human Services have also mandated far too many reporters, reports, and subjects of reports, making the NPDB a hornet's nest of potential problems for all kinds of healthcare practitioners:
- HHS regulations 45 CFR §§ 60.7 through 60.16 require adverse action reports from all these entities: insurers; licensing boards; other certification authorities; federal certification agencies; utilization and peer review organizations; accrediting bodies; hospitals; federal and state prosecutors; federal and state healthcare programs; federal and state law enforcement; and anti-fraud agencies;
- HHS regulation 45 CFR 60.5 requires reports of these matters: settlements; judgments; license and certification actions; other untold negative findings and adverse actions; criminal convictions; exclusions from reimbursement programs; and other adjudicated decisions of unspecified type;
- HHS regulation 45 CFR 60.1 requires reports on all “health care practitioners” potentially including not just doctors, nurses, physician assistants, and dentists but also therapists, psychologists, counselors, and any other licensed healthcare professional.
Too Much NPDB Access
HHS regulation 45 CFR 60.20 promises confidentiality of NPDB adverse action reports. But confidentiality is more of a joke or myth than a reality, given the vast number of authorized NPDB searchers and searches. Congress and the Department of Health & Human Services have authorized far too much access to the NPDB to reasonably control the flow of its too-often inaccurate and defamatory information. HHS regulations CFR 45 CFR 60.17 and 60.18 authorize NPDB access and searches by licensing boards, employers, hospitals, attorneys, law enforcement officials, utilization and peer review committee members, private health plan managers, and public officials administering agency healthcare programs. The same regulation requires that hospitals search the NPDB when hiring or offering privileges to healthcare practitioners and every two years thereafter. That's a lot of individuals from a lot of different entities making frequent searches of the NPDB, hunting for adverse information against you, each with their own motives, intentions, and interests.
You now see the huge risk of severe damage from inaccurate NPDB adverse action reports. What, though, can you do about it?
NPDB Adverse Action Report Disputes
Your primary remedy for an inaccurate and potentially damaging NPDB adverse action report is to move the report to disputed status. HHS regulation 45 CFR 60.21 permits you to challenge the accuracy of an adverse action report. If you properly complete your challenge, which you should do with our skilled and experienced representation, NPDB officials will move the inaccurate adverse action report to disputed status. Here are the steps for obtaining disputed status.
Receipt and Review of NPDB Adverse Action Report Notice
HHS regulation 45 CFR 60.21 states that NPDB officials “will routinely mail or transmit electronically to the subject a copy of the report filed in the NPDB.” The provision's clear intent is to give you a chance to review and dispute the new adverse action report. Indeed, the same regulation states expressly that you “may dispute the accuracy of a report” that concerns you. Once again, self-policing. Yet the regulation's odd inclusion of the adverb routinely suggests that NPDB officials may not always notify you. Indeed, NPDB officials apparently commit enough oversights in sending out their routine notices that the very next part of the regulation provides that “the subject may also request a copy of such report.” You may or may not get a notice. You may have to learn of the new report from your periodic self-query or someone else whose adverse action against you alerts you to the new report.
Attempting Voluntary Resolution
Once you get notice of the new inaccurate report, one way or another, HHS regulation 45 CFR 60.21 provides that to dispute it, you must first “attempt to enter into discussion with the reporting entity to resolve the dispute.” We can help you do so. Your efforts may be unavailing. After all, the reporter just accused you of some kind of serious reportable wrong. You've probably already challenged their allegation unsuccessfully. If not, they already mistrust you, in all probability, and are unlikely to take your assurances that their report is inaccurate.
How We Help with Voluntary Resolution
Instead of attempting voluntary resolution on your own, let us help you make a thorough, well-documented, and convincing presentation to the reporter. We can assemble, verify, and authenticate the documentation, while explaining in written and oral presentations why it clearly shows the report to be inaccurate. We can also alert the reporter that HHS regulation 45 CFR 60.22 withdraws the reporter's immunity from civil liability when the reporter “has actual knowledge of the falsity of the information contained in the report.” Guess what? Our presentation gives the reporter actual knowledge. We can, in other words, caution the reporter that the reporter may face your civil defamation lawsuit if the reporter does not correct or withdraw the inaccurate report because the reporter now has incontestable documentation supplying actual knowledge. We can be very convincing under these circumstances.
Moving the Inaccurate Adverse Action Report to Disputed Status
Simply contacting the reporter and attempting to negotiate a voluntary resolution does not move the inaccurate adverse action report to disputed status. No one, neither NPDB officials nor any individual or entity searching the NPDB, would necessarily know of your efforts. Instead, you should invoke NPDB procedures to mark your inaccurate adverse action report as in dispute status. Moving your inaccurate adverse action report to dispute status requires that you access your NPDB account, locate the inaccurate record, and enter your statement disputing the record. Once you complete the dispute status procedure, NPDB officials will mark the record as in dispute status, distribute your dispute statement to searchers who have obtained a copy of the inaccurate report, and send a copy of your dispute statement to the reporter, giving the reporter another chance to correct or withdraw the inaccurate report.
Drafting the Dispute Statement
Let us help you draft the dispute statement. Our attorneys have the research, writing, advocacy, and documentation skills to make a convincing showing in the statement that examiners of the inaccurate adverse action report should ignore it. Don't make a haphazard, incomplete, or unconvincing attempt at writing the statement yourself. Don't retain unqualified local attorneys to write the statement for you when they lack knowledge of NPDB procedures and the expectations of individuals and entities searching the NPDB. Get our highly qualified help. Your dispute statement may be the only way that you get to contradict the inaccurate report and counteract its damaging effects when searchers review it.
Moving the Inaccurate Adverse Action Report to Dispute Resolution
If the reporter does not voluntarily correct or withdraw the inaccurate adverse action report, HHS regulation 45 CFR 60.21 provides that you “may request that the Secretary review the report for accuracy.” See our explanation on a related webpage for how to appeal the inaccurate adverse action report to the HHS Secretary. Don't attempt an appeal on your own. Let our skilled and experienced attorneys do so. We know the showing that the appeal review standard requires, the procedures to follow, and the documentation and argumentation that an effective appeal requires. The regulation gives the Secretary thirty days to make a decision. The regulation further requires NPDB officials to enter the decision in the NPDB and share the decision with searchers who have obtained a copy of the inaccurate report.
The Benefit of NPDB Dispute Status
Moving your inaccurate NPDB adverse action report to disputed status can provide all or most of the remedy you need. Your goal is to counteract the negative effect of the inaccurate adverse action report. Your best outcome is to see the inaccurate report withdrawn. Our help moving the report to dispute status and through an appeal may well result in the report's voluntary withdrawal or involuntary expungement or correction by the HHS Secretary. But even if the reporter does not withdraw the report or the Secretary does not expunge it, our statement on your behalf, entered into your NPDB record and distributed to any entity searching for and discovering the inaccurate record may accomplish all you need in correcting the record. Once anyone reads our statement on your behalf, you've likely won the argument. They'll know just how competent, fit, responsible, and valuable you are as a licensed healthcare practitioner.
Premier NPDB Dispute Representation
If you need to dispute an adverse National Practitioner Data Bank action report, retain the Lento Law Firm's Professional License Defense Team to help you properly complete the NPDB dispute status procedure. Call 888.535.3686 or complete this contact form now for our skilled and experienced representation.
