National Practitioner Data Bank

The National Practitioner Data Bank (NPDB) is an electronic repository of all payments made on behalf of physicians in connection with medical malpractice settlements or judgments as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of physicians and other health care practitioners. The NPDB was established by Congress as part of the Health Care Quality Improvement Act of 1986 (42 U.S.C. 11101, et seq.). By federal law, information on all medical malpractice payments and on certain adverse actions must be reported to the NPDB. In turn, the NPDB is required to make this information available to hospitals, state licensure boards, some professional societies, and other health care entities under certain circumstances. The information is considered confidential and is released only to the eligible entities or to physicians and other health care practitioners who wish to conduct a self-query.

Section 1921 of the Social Security Act authorized the NPDB to collect additional information concerning negative findings and sanctions imposed by state licensing authorities, peer review organizations and private accreditation organizations, against various health care practitioners.  The U.S. Department of Health and Human Services (DHHS) is currently considering comments to its proposed regulations for implementation of Section 1921. Read the AMA's 2006 comments on the proposed changes, or learn more about Section 1921 here.

NPDB reporting requirements

The NPDB collects and disseminates the following information:

Professional liability payments made on behalf of a physician, dentist, or health care practitioner.

Adverse action reports based on a physician or dentist's professional competence or conduct that adversely affects the physician's or dentist's privileges for more than 30 days. These actions include reducing, restricting, suspending, revoking, or denying privileges, and also include an entity's decision not to renew a physician's or dentist's privileges if the decision was based on competence or professional misconduct. It also includes voluntary surrender or restriction of privileges either while under investigation or in lieu of an investigation. Other health care practitioners, in addition to physicians and dentists, may be reported. However, this is within the discretion of the health care entity.

Disciplinary actions related to competence or professional misconduct taken against a physician's or dentist's license, including revocation, suspension, censure, reprimand, probation, and licensure surrender.

Professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society.

Medicare and Medicaid exclusion reports containing sanctions against a practitioner from the Medicare program or the Medicaid program due to fraud and abuse.

Professional repercussions of a NPDB report

Even though the NPDB collects different types of information, a majority of the data collected consists of malpractice claims data against physicians. The AMA believes that malpractice claims data is a poor indicator of quality.

Nevertheless, the NPDB is required to make this information available to hospitals, state licensure boards, some professional societies, and other health-care entities under certain circumstances. Despite the lack of a connection between malpractice claims data and quality, the data is intended to serve as a flagging or alert mechanism to put parties on notice that the physician may have competence or professional misconduct problems.

Demands are increasing for this information to be made available to the public. Similar information may be available upon written request through the state licensing boards. Some licensing boards are even releasing this data through their web sites.

How to evade a report to the NPDB or ensure that the information in the report is accurate

Due to widespread dissemination of settlement information, it is imperative that settlement decisions be carefully evaluated-as even the settlement of a nuisance case with no real merit may have an impact on the physician's record with the NPDB. This record can affect licensure, medical staff privileges, contractual arrangements with health plans, and future insurability by traditional carriers

It is also important for the physician to ensure that the information contained in the NPDB is accurate. Reports are routinely mailed to physicians when they are submitted to the NPDB. Check any reports as they come to you and also consider requesting a copy of the report for review.

If you disagree with the information contained within a report, you may dispute it. Alternatively, if the information is technically accurate but misleading, you may wish to append your own statement relative to the events to the actual report. The statement is limited to 2,000 characters, including spaces and punctuation. The statement would be released with the report to all future queries of the NPDB, and notification of the statement would be sent to all queriers who previously received the report. The statements are entered into the computer system exactly as submitted to the NPDB and cannot be changed. So, be sure to stay within the space limitations. You may wish to consult an attorney for help in drafting the short piece to get the maximum effect of the limited opportunity to tell your side of the story.

For information about filing a statement or other information relative to the NPDB, visit the National Practitioner Data Bank Web Site or call the NPDB Help Line at (800) 767-6732 for recordings on common NPDB topics and developments seven days a week, 24 hours a day. To speak with a person live, call between the hours of 8:30 a.m. to 6:00 p.m. (5:30 p.m. on Fridays) Eastern Time.