Everything Physicians Need to Know about the National Practitioner Data Bank (NPDB)

If you are a licensed physician accused of misconduct, you stand to lose more than just your license to practice in a particular state: you risk losing the ability to practice anywhere. The reason for this is that since the late 1980s, all adverse actions against physicians are required to be reported to the National Practitioner Data Bank (NPDB), a national data clearinghouse designed to promote patient safety and protect the public from providers who may pose a threat.

If you've been disciplined for malpractice or had any type of disciplinary action imposed by a licensing board, chances are it will show up on this database. The NPDB receives reports on a variety of adverse actions, including malpractice payments, licensure and disciplinary actions, and adverse clinical privileges actions. It is used by state licensing boards, hospitals, and other healthcare entities to identify and investigate problem physicians and healthcare providers.

Understandably, a negative report on NPDB can have serious consequences for your career and reputation as a physician. It can make it difficult to obtain a license in another state, to obtain malpractice insurance, or to secure employment at certain healthcare facilities. That's why it's so critical to hire skilled legal counsel to defend your license against allegations of wrongdoing. Attorney Joseph D. Lento and his Professional License Defense Team have nationwide experience representing doctors facing license discipline issues. Not only can they assist you with disputes over inaccurate information in NPDB reports, but they can also provide a skilled defense to help you avoid adverse actions from occurring in the first place. To schedule a consultation, contact the Lento Law Firm at 888-535-3686.

History of the NPDB

The NPDB was established by the Health Care Quality Improvement Act (HCQUIA) of 1986. This came in response to increasing public concern over the competency of medical practitioners and the lack of a mechanism to prevent incompetent physicians from moving from state to state without disclosing their previous damaging performance. The NPDB was created as a centralized database to improve healthcare quality and promote accountability. It was officially activated in September 1990 and has since been administered by the U.S. Department of Health and Human Services.

NPDB Reporting: Who, What, and When

Entities that report to the NPDB include hospitals, other healthcare entities, professional societies, medical malpractice payers, and state licensing boards. We should note that if an adverse action occurs against you, there's no room for negotiation as to whether it appears in the NPDB; these entities are required by law to report specific actions within 30 days of the final action. (It's another reason why it's so important to try and resolve complaints with your state licensing board before disciplinary actions are imposed.)

Reportable actions include medical malpractice payments, clinical privileges actions, professional society membership actions, licensure actions by Boards of Medical Examiners, DEA actions, exclusion from Medicare and Medicaid, and other adjudicated actions or decisions. The reporting requirements are detailed and complex, with variations depending on the nature of the action and the organization responsible for the reporting.

Is the NPDB a Public Database?

No, it isn't. While the NPDB houses a significant amount of data, access to this information is strictly controlled. Only eligible registered entities can query the databank. Individual practitioners can access their own records but cannot access information about other practitioners.

What Happens When an Entity Reports Something About Me to the NPDB?

When the NPDB receives a report about you, the law requires them to send you a notification letter in the mail. The notification will include a report number and temporary password for you to log in to the data bank and review the report.

How a Negative NPDB Report Can Impact Your Career

Information in the NPDB can have serious ramifications for your career. When a report is made, it becomes part of your permanent professional record in the data bank. Hospitals, medical boards, and other healthcare entities have access to this information when making determinations about licensure, clinical privileges, and employment. Not surprisingly, this can potentially disrupt your career in any or all of the following ways.

Denial of Employment

Many healthcare entities use this database to screen prospective hires, and a report of misconduct can make it difficult to secure a job. Employers may be hesitant to take on someone with a history of disciplinary action, malpractice payments, or other adverse actions.

Loss of Clinical Privileges

If you hold clinical privileges at a hospital or healthcare facility, a negative NPDB report could lead to suspension or revocation of those privileges. This can be devastating for your career, particularly if you predominantly practice at that facility.

Denial of Professional Licensure or Practice Restrictions

State medical boards are able to query the NPDB when considering applications for licensure. If you had your medical license revoked in Iowa, for example, and you moved to New Jersey and applied for licensure there, the New Jersey State Board of Medical Examiners can check the data bank and see that your license in Iowa was revoked, and this may be cause to deny your application. Even if you had other, lesser sanctions on your prior license, the Board has the right either to deny your license or to impose strict conditions on your license if they decide to approve it.

Denied Entry into Professional Associations

Professional medical associations that could enhance your public credibility and provide career advancement opportunities can also query the NPDB when considering your membership. Adverse actions may be grounds for these types of organizations to deny you membership, putting a damper on your ability to expand your professional network and find new opportunities for growth.

Can a Negative Report on the NPDB Affect My Ability to Get Malpractice Insurance?

No. While malpractice payers are required by law to report payments to the NPDB, they are not permitted to query the data bank when considering you as an insured physician.

Accessing Your NPDB Report

Physicians have the right to self-query the NPDB to view their records at any time. You should regularly check your record for accuracy and completeness. To self-query, you need to visit the NPDB website and complete the online request form. There is a nominal fee for the self-query service. While you should be notified anytime a report about you is entered into your NPDB record, it's still good practice to do a self-query periodically--if for no other reason than to see what information is available about you and how you can respond to potential employers or licensing boards if adverse actions appear there.

Disputing Information in Your NPDB Report

The NPDB has an obligation to maintain accurate records as much as possible. You can file a request to make changes to identifying information about you, such as your name, address, contact information, etc. However, they are prohibited by law from removing information that appears about you. Only the entity that reported the information has the ability to correct or remove inaccurate information in a report.

That said, if you disagree with the accuracy of any negative information in your report, you have the right to dispute or counter that information. Your options for responding to negative information include the following.

Submitting a Statement

At any time, whether or not you attempt to dispute a report, you have the right to submit a written statement to the NPDB to provide an explanation or context regarding any report made about you. You can also log in and edit your statement at any time. (You can also include a statement with any dispute you make.)

Disputing the Report

You have the right to dispute inaccurate or incomplete information in your NPDB report. The dispute process begins with contacting the entity that submitted the report, detailing the inaccuracies, and requesting a correction or voiding of the report. If the organization doesn't respond satisfactorily, you may then file an official dispute, which becomes part of the record along with any statement you might wish to add to the report. The NPDB notifies the organization, and they have 60 days to correct the report, void it, or let it stand as submitted.

Dispute Resolution

If the reporting entity does not amend the report to your satisfaction--or if they simply don't respond--you can then elevate the report to dispute resolution, at which case the report will be reviewed by the U.S. Department of Health and Human Services. You will want to provide evidence that shows the inaccuracies in the report, along with proof that you took the necessary steps to try to resolve the inaccuracies with the organization that created the report. Bear in mind that this review will not assess the merit of the action reported, but rather will determine only the following:

  • Whether the entity in question was eligible to file a report;
  • Whether the report met NPDB's reporting requirements; and
  • Whether the report accurately recounts the action taken against you and the reason for the action.

After their review, the DHHS will make a determination whether to let the record stand, correct it, or remove it from the NPDB.

How We Can Help: Preventing or Limiting Damage from Your NPDB Report

An adverse action appearing on your NPDB record should be thought of as a "point of no return." Once it appears on your record (provided the information is accurate), it's effectively indelible, and there's little that any attorney can do to have it removed. However, that doesn't necessarily mean a negative report to the NPDB is automatically a death sentence for your career. (Consider the fact that many physicians have adverse actions on their records and are still practicing.) The Professional License Defense Team at the Lento Law Firm can implement many strategies to help you navigate allegations of misconduct, including dealing with any negative information that may be reported to the NPDB. Here are just a few ways that we can help.

Resolve Complaints Before They Become Adverse Actions

When it comes to reports to the National Practitioner Data Bank, the phrase "an ounce of prevention is worth a pound of cure" certainly applies. The best way to keep an NPDB report from impacting your career is to do whatever is possible to keep it from being reported in the first place--and that means dealing with the allegation at the state level. Our team understands the disciplinary processes of medical licensing boards nationwide, and we can work to mitigate the damage before it becomes necessary for them to report to the NPDB. These strategies may include:

  • Disproving the complaint and having the complaint dismissed
  • Negotiating with the Board for a private sanction (some states allow certain disciplinary actions to stay out of the public record)
  • Negotiating for more lenient sanctions so any adverse action reported to the NPDB has a minimal impact

Work for Reinstatement of Your License

Just as adverse actions must be reported to the NPDB, any revisions to those actions must also be reported. That means, for example, if the Board reports that your medical license was revoked, they must also report to the NPDB if and when your license is reinstated. Our team can work to help you find a path toward license reinstatement or a reversal of other sanctions--and make sure that reversal gets reported to the NPDB when it happens.

Disputing Inaccurate NPDB Reports

If you have a legitimate reason to dispute an adverse action report on your NPDB record (for example, they inaccurately reported an action against you that did not occur), our team can help coordinate the dispute process, presenting the necessary evidence to have the record corrected or vacated. We can also assist with crafting supplementary statements so any entities that query your record will have a clear context of what happened.

Representing You to Medical Boards When Necessary

If the worst happens and a particularly damaging adverse action appears on your NPDB record, it could affect how future licensing boards might consider your application. If necessary, we can step in as your official representative to provide context to the medical board to improve your chances for licensure despite the negative report.

Whether you're a physician facing allegations that could result in a negative NPDB report or struggling against a report that has already been made, Attorney Joseph D. Lento and his Professional License Defense Team have the nationwide experience you need to minimize the damage to your career. At the first sign of trouble, reach out to the Lento Law Firm at 888-535-3686 or contact us using our online form.


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