NPDB Reporting Requirements

National Practitioner Data Bank Reporting Requirements

Our Georgia-based healthcare law firm represents both employers and physician employees with regard to issues concerning NPDB reporting requirements and associated consequences. Adverse consequences from or associated with a misstep in NPDB reporting can be severe and permanent.  Therefore, NPDB reporting is of potential high stakes importance for both employer or other reporting entity and the reported physician. Whether representing a hospital system, other reporting healthcare entity, or a physician, we accept legal engagements to assist our clients in navigating the critical legal issues that emanate from NPDB Reporting situations.

What We Do to Help

We are a healthcare law firm that handles NPDB matters.  Our firm’s role often involves both advisory and advocacy functions in these matters. We represent hospitals and other reporting entities to advise and assist them in determining whether and how to properly report matters to the NPDB.  We also represent physicians who are the subject of NPDB reports to protect their interests throughout the process. For reporting entities and for physicians, we also handle NPDB appeals and related dispute resolution steps and processes, whether at the administrative or judicial relief level.  Because prior NPDB reporting can permanently adversely affect credentialing and employment opportunities for physicians, we assist medical practices and physicians with such issues.

An NPDB Reporting Primer

In connection with the rising number of medical malpractice lawsuits and the attending possibility that a doctor with a history of malpractice suits could move from state to state without his/her history being known, Federal law known as the Healthcare Quality Improvement Act of 1986 (HCQIA) was introduced by Congressman Ron Wyden (Oregon) and passed, as 42 U.S.C. § 11101-11152. Pursuant to HCQIA, federal law provides qualified immunity to hospital systems from liability for peer review participation to physicians and created the NPDB to track certain indicators of quality of care (e.g., a medical malpractice payment) and enacted procedural rules for due process, privilege restrictions, and reporting and disbursement of information.  On the one hand, this immunity is imperative in many circumstances for hospitals and other healthcare entities; on the other hand, an NPDB report can harm a physician’s career. Therefore, the process by which NPDB reporting occurs, the NPDB Guidelines, and the appeal rights and remedies for mistaken or inaccurate reporting, can be critical for the reporting entity and the physician.

The following and many similar types of events can mandate reporting to the NPDB:

• Medical malpractice payments
• Federal and state licensure and certification actions
• Adverse clinical privileges actions
• Adverse professional society membership actions
• Negative actions or findings by private accreditation organizations and peer review organizations
• Health care-related criminal convictions and civil judgments
• Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
• Other adjudicated actions or decisions

For hospitals or other healthcare entities subject to HCQIA’s purview, the immunities from suit and protections of peer review process can be compromised if NPDB reporting requirements are not followed.  On the other hand, where NPDB reporting is improper, the reporting entity may face litigation risks presented by the subject of the reporting.

For the physician employee or other professional that is the subject of NPDB reporting, the adverse consequences can be material and permanent. Fortunately, HRSA and the NPDB provide a dispute resolution and appeals process by which a physician who is the subject of an improperly filed or inaccurate NPDB report can seek to have the report removed or changed.  Where this process fails to obtain a desired outcome, a physician may have an opportunity to seek judicial relief, depending upon the circumstances.

Given the stakes for reporting entities and the subjects of NPDB reports, perfect clarity in the NPDB reporting guidelines would be ideal; however, that is not always the case.  While NPDB reporting requirements can be clear, often there are more nebulous circumstances that can create difficulty, such as when an “investigation” occurs where the hospital’s medical staff has some degree of concern about quality of care delivered by an employed doctor.  Where NPDB reporting is an issue, affected parties should tread carefully. The process that should be followed by the hospital, and the options available to an affected physician, are ideally managed and handled by qualified healthcare counsel.

We Would Like to Meet You

Our firm exclusively represents healthcare providers.  We have offices in mid-town Atlanta and in the Medical District of Augusta, Georgia.  Our firm is AV-rated by Martindale Hubbell and has significant experience helping physicians and employers with regard to NPDB reporting issues, disputes, and similar professional concerns.  To schedule a consultation, contact us at our office nearest you or email us at info@hamillittle.com.