New federal data bank collecting, disclosing fraud actions

The Healthcare Integrity and Protection Data Bank began disclosing adverse actions March 6.

By Sarah A. Klein, amednews staff. March 20, 2000.

The government's new fraud data bank began disclosing adverse actions taken against physicians, other health care practitioners and suppliers on March 6.

The Healthcare Integrity and Protection Data Bank, which was mandated by the Health Insurance Portability and Accountability Act of 1996, reports licensing actions, exclusions from the Medicare and Medicaid programs, criminal convictions and civil judgments related to health care. The data are supplied by state and federal law enforcement organizations, licensing and certifying boards and private health plans. Those agencies and entities are required to report all final adverse actions taken since Aug. 21, 1996.

The data bank does not contain information on settlements in which no admission of liability is made; nor does it contain malpractice findings or overpayment determinations by Health Care Financing Administration contractors.

Launched last year to combat health care fraud, the data bank is designed to complement the 10-year-old National Practitioner Data Bank. The NPDB contains reports of medical malpractice and adverse licensing and professional society actions taken against some 146,000 physicians and dentists.

According to a March 3 notice in the Federal Register, physicians can query the data bank for a $10 charge. Health plans and insurers pay $4 per query. State law enforcement agencies also pay $4. Federal agencies can request the information for free.

The general public does not have access to HIPDB information.

Physicians who wish to dispute information contained in the data bank must contact the agency or insurer that reported the violation. If the reporting entity chooses not to change the report, the physician, practitioner or supplier can add a statement to the report or request that the Secretary of the Dept. of Health and Human Services review the report.

To submit queries, physicians must use the HIPDB Web site (http://www.npdb-hipdb.com/); the specific guidelines for querying can be found there.