National Practitioner Data Bank (NPDB) Self Query

As a licensed healthcare practitioner, whether a physician, nurse, dentist, or other health field professional, you should be well aware of the U.S. Department of Health & Human Services' National Practitioner Data Bank (NPDB). Indeed, you should be specifically aware of what the NPDB reports on your professional status file. An adverse action report against your professional NPDB record can severely impact your healthcare practice, including leading to loss of your privileges, employment, and license. Thus, you should be making periodic self queries of the NPDB to ensure that your record remains clean and clear of false, incomplete, or out of date adverse action reports. Retain the Lento Law Firm's premier Professional License Defense Team if you have trouble gaining self query access to your NPDB record or other issues relating to your NPDB self query. Call 888.535.3686 or complete this contact form now for our highly qualified representation and to address and correct NPDB issues. This information addresses NPDB self query issues.

What Is the National Practitioner Data Bank

The federal Health Care Quality Improvement Act of 1986 authorized the Department of Health & Human Services to establish and maintain the National Practitioner Data Bank. Since the NPDB's release in 1990, it has served as a collection point for nationwide disciplinary actions and other adverse action records involving healthcare professionals. Until then, determining a healthcare professional's record involved searches of fifty state licensing board databases, civil and criminal court files in all jurisdictions, and other records, making a comprehensive review practically impossible. Congress addressed the need to protect patients and the public against unqualified healthcare practitioners by creating the NPDB and requiring that state licensing boards and other entities submit adverse action reports. HHS maintains the NPDB in an updated form that is searchable by practitioner name, license number, and related identifying information.

Who Searches the NPDB

The authorizing Health Care Quality Improvement Act, 42 USC Section 11101 et seq., and HHS regulations implementing the Act, limit NPDB access. Not everyone gets to rummage through the NPDB for negative information on healthcare practitioners. Individuals or entities searching the NPDB must have the right status and the right purpose or intent. Under CFR 45 CFR 60.17 and 60.18, HHS limits NPDB access to those entities in appropriate need of NPDB information, including the following entities for the following purposes:

• state licensing boards for the healthcare professions in the NPDB, to evaluate license applications, discipline, and renewals;
• hospitals and other employers of healthcare professionals, to evaluate employment recruiting, retention, discipline, and termination, including at application and within every two years thereafter;
• hospitals and other entities offering privileges to healthcare professionals, to evaluate requests for privileges and termination or restriction of privileges;
• attorneys suing a hospital for malpractice by a physician whom the attorney alleges in the malpractice complaint the hospital did not check the NPDB;
• law enforcement agencies in drug, fraud, and related investigations;
• utilization, quality control, and peer review organizations relative for evaluation and statistical purposes; and
• health plans and agencies administering health care programs, to determine qualification for participation and reimbursement.

Who Cannot Search the NPDB?

HHS prohibits searches by others not within the approved categories. HHS Regulation 60.20 expressly holds that NPDB information is confidential outside of authorized parties. Members of the public, including patients and their family members, do not generally have NPDB access. Members of the media do not have NPDB access. Healthcare professionals themselves do not have general NPDB access to search records of other healthcare professionals, unless those healthcare professionals occupy relevant positions of authority within an employer, licensing board, or utilization review organization already authorized for NPDB access, and their intention is to search the NPDB for that entity's authorized purpose.

Risks of NPDB Information Disclosure

Despite the limited access to NPDB information, you should already recognize from the above discussion how NPDB information can quickly get out and spread around your professional community. Your employer representatives, licensing board members and officials with whom you come into contact, utilization and peer review committee members, and health care plan managers form a significant part of your professional network. They all may know your NPDB adverse information. And they may talk with your other professional colleagues more than you would prefer. Before long, nearly everyone within your professional community may know. Even patients and their family members may soon hear of your NPDB adverse reports. That's why you should have a strong interest in completing periodic NPDB self query, to ensure only accurate and updated NPDB information.

What Adverse Information Is in the NPDB

HHS regulations 45 CFR 60.6 through 60.16 state the long list of adverse action reports that individuals and entities must submit to the NPDB. Those adverse action reports include nearly every negative piece of information about you that you can imagine a prospective employer, peer review committee, police agency, healthcare plan, or licensing board would want to know, including:

• § 60.6: errors and omissions you made;
• § 60.7: medical malpractice payments you made;
• § 60.8: licensure actions your medical board took;
• § 60.9: other state licensure and certification actions;
• § 60.10: federal licensure and certification actions;
• § 60.11: negative peer reviews;
• § 60.12: actions against your clinical privileges;
• § 60.13: federal or state criminal convictions related to healthcare services;
• § 60.14: civil judgments against you for healthcare services;
• § 60.15: exclusions from healthcare program participation; and
• § 60.16: other adjudicated actions or decisions against you.

Imagine how hazardous to your professional practice and reputation the above information could be, especially if inaccurate, false, exaggerated, or out of date, and especially if widely released into and through your professional community. Again, that's why you need and want to make regular NPDB self queries.

Potential NPDB Impacts

Consider the specific harm that false, out of date, and out of context NPDB action reports could cause you. You could certainly lose your professional license to discipline including suspension or revocation. However, you could also lose your opportunity to gain a new license in another state or jurisdiction. You could lose your current hospital privileges and the opportunity to gain privileges at a new hospital in your area or another location. You could also lose your current employment with a hospital, clinic, or practice group. You could also lose your opportunity to participate as a reimbursed practitioner in state and federal healthcare programs and private health plans. Any of these losses could bring with it substantial wage and income loss, loss of employment benefits, and loss of housing, transportation, and other personal assets and interests. Don't underestimate the potential effect of these losses on your mental and physical health and family and friends relationships.

Who Can Make an NPDB Self Query

So, you should now see clearly why you should want to make periodic NPDB self queries. Self queries facilitate your examination and correction of the NPDB. Without the right to self query, you wouldn't know whether you were suffering harm or in the future might suffer harm from an inaccurate NPDB record. You and other licensed healthcare professionals who have information in the NPDB have a right to self-query under HHS regulation 45 CFR 60.18, authorizing requests by a “health care practitioner who requests information concerning himself or herself.” Notice that your self query is only as to your own NPDB record, not the records of other healthcare practitioners, such as your professional colleagues. But you do have the right to NPDB self query.

Why Make NPDB Self Queries

To spell it out, NPDB records are sometimes inaccurate. Any administrative system can produce errors. However, a system as broad and complex as the NPDB is especially prone to errors. Lots of individuals and entities submit NPDB adverse action reports. The NPDB does not staff to review and background check every submitted action report. The NPDB largely relies on the submitters and the self query system to catch and correct errors. The problem is that when an NPDB record contains an error, it can produce very harsh and inappropriate results for the involved healthcare practitioner. The NPDB has surely served its purpose. But at what cost, not only in terms of the time, effort, and expense all the self-checking requires but also in the loss that innocent healthcare practitioners suffer. Your employer or licensing board may not wait around to let you explain away a mistaken or out of date adverse action report. They may pull your license or terminate your employment simply for safety and liability sake. So, yes, make periodic NPDB self queries.

How to Make an NPDB Self Query

HHS regulation 45 CFR 60.18 leaves it to the HHS Secretary to determine how to make an NPDB self query: “Persons and entities may obtain information from the NPDB by submitting a request in such form and manner as the Secretary may prescribe.” The HHS website thus explains its basic self query process. You begin your self query by completing the HHS Self-Query order form. If your submission of the form matches no NPDB information, then you should get that no-match response. If instead your submission triggers a match, then you should get a response indicating a match. The response may reflect matching medical malpractice payments, adverse license actions, actions against your privileges, or civil judgments and criminal convictions. An NPDB full report should soon follow. Initial responses should take just minutes. If you request a mailed copy of the full report, then you'll have to wait for the U.S. mail.

Common NPDB Self Query Issues

The NPDB self query system should be fast and efficient. But unfortunately, it has all the common hazards, bugs, errors, and frustrations of any online administrative system. You may encounter any of the following issues:

• forgot your NPDB ID.me account password;
• multi-factor identification notices are not reaching you;
• NPDB ID.me account will not accept your ID verification;
• NPDB has deleted or won't recognize your account;
• you have duplicate NPDB accounts;
• locked out of your NPDB ID.me account;
• you need to update your NPDB account for a name change or other information but are unable to do so;
• NPDB does not respond to your self query order form;
• NPDB won't accept your payment for self query records;
• NPDB won't verify your NPDB response;
• you need to edit your order form but are unable to do so;
• confusion, contradiction, or mismatch between your self query order form and the NPDB submitted information;
• failure to match despite knowing you have an NPDB record;
• match reflecting someone else's NPDB record;
• inaccurate NPDB record misidentifying you as subject to an adverse action you did not suffer;
• inaccurate NPDB record misstating and exaggerating the nature of an adverse action you suffered;
• out of date NPDB record indicating an adverse action since corrected, satisfied, or withdrawn.

What to Do About NPDB Self Query Issues

You may have certain things you can do to address self query issues, within your own reach and constraints. For instance, the HHS NPDB website has extensive FAQs, self-help answers, and a video tutorial. However, as with any such online administrative system, the online explanations nonetheless have limited help for many of the problems you may encounter. And if you need to reach a living person, you may find the HHS NPDB email and telephone inquiry services to be understaffed, unhelpful, or simply non-responsive. You may not be able to get anyone to pick the telephone, and if you do, they may not be willing or able to solve your problem, or they may offer assurances on which the system does not follow through. We've all been in the position of holding on the telephone line for hours at a time, attempting to get an agency's help, only to suffer an automatic disconnect.

How We Help with NPDB Self Query Issues

Don't just feel helpless in the face of the NPDB self query issues, but succumb to its bureaucratic challenges. Instead, retain us to take swift, sure, and effective action on your behalf. Our attorneys know how to address self query issues. When we contact HHS NPDB staff, appearing as attorneys on your behalf, we usually get the attention of staff members that your matter deserves. Our prior work with NPDB staff on other client matters gives us the contacts, reputation, and relationship to facilitate a prompt and effective NPDB response. We may also reach, communicate, and advocate with HHS oversight officials to ensure that the HHS NPDB system remains accountable. We can, in other words, advance your matter up the hierarchy until we obtain an effective response.

The Value of Our Reputation, Role, and Skills

We also have the ability to respond promptly, diplomatically, but firmly and clearly with the trustworthy information and assurances that NPDB staff members may need to act on your matter. NPDB staff generally do not trust unrepresented individuals to the same degree that they can rely on attorneys who practice before HHS. NPDB staff do not know you. They may know us, and even if they do not have a prior working relationship with us, they know that our attorneys carry law licenses that require our honesty and reliability in all matters. We can notarize and otherwise certify the authenticity of your signature, attestation, and representations. We can also supply the additional documentation NPDB staff may require to respond in ways that advance and resolve your NPDB issues.

Workarounds to NPDB Self Query Issues

Our attorneys may also have ways to work around your NPDB self query issues. Your goal is not to complete an NPDB self query. Completing your self query is only one helpful objective toward your deeper goal of confirming or correcting the accuracy of your NPDB record. We may be able to obtain a search and disclosure of your NPDB record through another source or means other than a self query, to accomplish the same thing that a self query would accomplish. You just need to ensure your NPDB record is accurate. Others may be able to help us do so. And if our query through other individuals or entities, or through other means, produces a match that shows an NPDB error, then we can either go through NPDB dispute status and dispute resolution processes, or work with the submitting individual or entity for their self-correction of the erroneous record.

Resolving by Other Means Self Query Issues

The prior discussion shows that you may have other alternatives to correct an inaccurate NPDB record revealed on self query or a helpful accomplice's proper search. Our attorneys may be able to reach, communicate, advocate, and negotiate with the individual or entity submitting the inaccurate record. Ordinarily, reporters of adverse actions are reluctant to take the healthcare practitioner's pleading and assurances as a grounds for correcting the submitted record. The reporter may already mistrust the reported healthcare practitioner. But our advocacy on your behalf may lead the reporter to understand the nature of the reporter's error. We may be able to share documentation, statements, affidavits, medical records, business records, or other materials making a strong or even compelling case for the correction, by the reporter, rather than wading into and through NPDB dispute resolution channels.

Risks to Erroneous NPDB Adverse Action Reports

Another way our attorneys may be able to convince an adverse action reporter to correct an erroneous NPDB adverse action report revealed on self query is to show the reporter the potential civil liability for defamation, for false statements impugning your good moral character and professional competence. HHS regulation 45 CFR 60.22 grants immunity from civil liability to NPDB adverse action reporters. However, the regulation eliminates immunity and once again exposes the reporter to civil liability when “the individual, entity, or authorized agent submitting the report has actual knowledge of the falsity of the information contained in the report.” Once we show the reporter the evidence that the report is false, the reporter may appreciate the risk of civil liability and voluntarily correct or withdraw the erroneous report.

Other Ways We Help You with NPDB Issues

If you learn from our successful self query on your behalf that your NPDB record has an accurate or out of date adverse action report, we can help you place that report in dispute status. If NPDB does not correct the disputed action report, we can then help you ensure that your disputed report qualifies for dispute resolution status. Once we qualify your disputed report for dispute resolution, we can represent you in the dispute resolution process, including completing in an accurate and compelling fashion all documentation and other requirements for favorable dispute resolution. We can simultaneously work with the entity submitting the disputed report, to ensure that the entity agrees to and facilitates the report's correction.

Ways We Help You Avoid NPDB Issues

It bears brief mention that we can also help you avoid NPDB issues before they arise. We can advocate with your licensing board in disciplinary proceedings, responding to investigations and conducting hearings and appeals. We can also work with your employer and hospital at which you hold privileges, to challenge misconduct, unfitness, or unprofessionalism allegations, to avoid an NPDB report. And if you receive notice of an NPDB adverse action report, we can help you challenge that report so that it does not become a part of your permanent NPDB record.

Premier NPDB Self Query Representation

If you face National Practitioner Data Bank self query issues, or NPDB issues of any other kind, retain the Lento Law Firm's premier Professional License Defense Team to help you favorably resolve those issues and avoid harm to your professional employment, practice, licensure, and career. Avoid retaining unqualified local criminal defense counsel or an unqualified local attorney in another field of law. NPDB self query rules and resolution procedures differ from court rules and procedures. Call 888.535.3686 or complete this contact form now for our highly qualified representation, for your best NPDB self query outcome.