National Provider Data Bank Dispute Resolution and Appeals

Our healthcare lawyers represent physicians and other providers who are the subjects of adverse, improper or inaccurate reporting to the National Provider Data Bank (NPDB or the “Data Bank”). The focus of our law practice is advising and representing physicians, other providers and healthcare businesses, and professionals with regard to regulatory and business issues that impact their status as professionals. We have represented hundreds of physicians with regard to serious career-impacting legal issues, including adverse NPDB reports.

Atlanta/Augusta, Georgia Physician Credentialing Attorneys

When a report is filed with the Data Bank, the immediate and long-term consequences for a physician who is the subject of the report can be severe and include devastating financial consequences that are often impossible to fully anticipate at the time of the report. The consequences have been described as a “domino effect” with regard to the physician’s (or other provider’s) state medical board, hospital privileges, employment, managed care and third party payer contracts, and professional societies. This is a very serious issue for physicians and other health care providers.

Fortunately, the law provides procedures by which NPDB reporting that is either inaccurate or contains non-reportable information can be challenged. There are specific steps and procedures required by the NPDB to properly challenge a report. Also, effective negotiations with the reporting healthcare entity can result in a corrected or removed report. If the reporting entity refuses to correct an adverse report, the physician is permitted by law to: (1) add a statement to the report; (2) initiate a dispute or challenge of the report; or (3) add a statement and initiate a dispute.

Where a challenge to an NPDB report is successful, HRSA will order the reporting health care entity or government agency to void and remove the report or to revise it to make it accurate. We assist and advocate for physicians in the following types of legal engagements that concern the Data Bank:

  • Disputing status of an adverse report
  • Challenging inaccurate reporting
  • Challenging reports that contain non-reportable information
  • Representation and advocacy throughout HRSA’s appeals/dispute resolution procedures for an adverse report
  • Representation and advocating to and negotiating with reporting entities and agencies
  • Credentialing litigation

The National Provider Data Bank was created under the auspices of the Health Care Improvement Act (HCIA) of 1986. The impetus for this law was congressional desire to improve the quality of medical peer review. The intention was to create a data bank that would be a clearinghouse of information by which hospitals, medical boards, and other healthcare entities could learn, through an investigative process, of important facts regarding the qualifications and experiences of providers they might wish to employ, license, allow membership, etc. The U.S. Department of Health and Human Resources (HHS), through the Health Resources and Services Administration (HRSA), operates the Data Bank.

Under the HCIA, certain types of information must be reported to the NPDB, including medical malpractice payments; certain types of “adverse actions” against providers by governmental agencies, hospitals and healthcare entities; and sanctions by state medical boards.

Georgia Health Care Lawyers

If you are (or believe that you will be) the subject of an NPDB report, you should consult with your attorney to discuss your rights and legal options under HCIA to best protect your career, professional and financial interests. If you have questions about the NPDB process, our firm can help. Contact us today for a free initial consultation.