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How Can a Health Care Provider Challenge a NPDB Report?

In 1986 Congress enacted the Health Care Quality Improvement Act of 1986 (HCQIA). Part of that Act was designed to prevent incompetent health care providers from moving amongst states to avoid the discovery of their incompetence. 42 U.S.C. § 11101. A central part of that mission was the creation of the National Practitioner Data Bank (NPDB), which collects and releases certain information about health care providers. 44 C.F.R. § 60.1. Practitioners should know, however, that the contents of the NPDB are not accessible to the general public. 5 U.S.C. § 552.

Generally speaking, medical malpractice payments, adverse state licensure actions, adverse professional review actions, exclusions from Medicaid / Medicare, or the surrender of clinical privileges while under investigation all trigger a reportable offense to the NPDB. 42 U.S.C. § 11131, et seq. Reporting entities / individuals are afforded certain statutory immunity rights so as to promote compliance with the letter and spirit of the law. See, 42 U.S.C. 11111, et. seq. and 11137. Information collected by the NPDB is then available to state licensing boards, insurers, and hospitals who are statutorily required to check on a physician’s credentials. See, 42 U.S.C. § 11135.

It is not uncommon for a health care provider who is the subject of a NPDB report to seek to challenge the contents of that report. This is a right statutorily afforded to the subjects of such NPDB reports. See, 42 C.F.R. § 60.16. Generally, the subject of a report has sixty (60) days to submit a written notice challenging the accuracy of the report and to initiate discussions with the reporting entity to resolve the dispute. 42 C.F.R. 60.16. If the subject of the report and reporting entity cannot reach a resolution, the Department of Health and Human Services (DHHS) will review written information submitted by both parties and issue a report. Id.

For those interested in obtaining more information regarding the NPDB, DHHS provides a Guidebook which is easily accessible on line. See, https://www.npdb-hipdb.hrsa.gov/resources/aboutGuidebooks.jsp. Health care providers with questions either as to their responsibility to report certain actions, or seeking to challenge a report, should consult with legal counsel for specific guidance. For more information on the National Practitioner Databank, contact the attorneys at Walker, Murphy & Nelson, LLP today.

Disclaimer: This article is for general informational purposes only. Nothing contained herein constitutes legal advice, nor does it create an attorney-client relationship. All persons reviewing this should consult counsel for advice regarding any specific legal questions and any unauthorized use of this information is expressly prohibited.