What Happens When A Physician Is Reported to the National Practitioner Data Bank (NPDB)?
- 2 days ago
- 7 min read
Unfortunately, some doctors in our online physician communities have found themselves in a situation where they are notified that they will be or have been reported to the National Practitioner Data Bank (NPDB). This can be a very scary and anxiety provoking situation, as there are many potential implications for your career. However, it’s important to understand that not all reports and incidents on the NPDB are equally consequential. Additionally, there may be actions that you can take to protect yourself, so it’s important not to ignore it or take it as fact. Below, we’ll cover what you need to know about the NPDB and what to do if you’ve been notified that you have been reported or may face being reported. As always, consult with appropriate legal expertise before making any decisions based on the information in this article, as there are many nuances to this.
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What is the National Practitioner Data Bank (NPDB)?
The National Practitioner Data Bank (NPDB) is a confidential database that was created by Congress, with its stated mission being to improve healthcare quality, protect the public, and reduce healthcare fraud. It tracks things like malpractice settlements, investigations into or disciplinary actions against a physician, and any restrictions of a physician’s privileges (more details below).
It’s used by hospitals, credentialing committees, state medical and licensing boards, federal and state law enforcement entities, professional and specialty societies, and third-party payers to assist them in looking into the background of clinicians. These entities, as well as federal agencies such as the DEA and OIG, those making malpractice payments, and others are able to file reports.
Importantly, confidential means that it can not be directly accessed by the public or your patients.
What types of things get reported to the NPDB, and how long do they stay on your record?
Per the NPDB website, the NPDB collects information and maintains reports on:
Medical malpractice payments (made on behalf of practitioners)
Federal and state licensure 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 judgements
Exclusions from Medicare/Medicaid or other government health care programs
Other adjudicated actions or decisions
The process and nuances of putting a rental property into an LLC differs depending on whether the property is initially acquired through an LLC, or whether it’s transferred to an LLC after purchase.
Reports generally stay on your record forever, so you should take a report seriously, as it will become a part of your permanent record.
What is the impact on your career if you’ve been reported to the NPDB?
Generally speaking, going forward, actions reported on your NPDB profile will be an issue that surfaces during times of job searches, credentialing, licensing, hospital privileges, and acquiring malpractice coverage.
The consequences of being reported to the NPDB can be far reaching and significant, even impacting your ability to practice or get paid for what you do, or secure adequate malpractice coverage.
Hiring, Job Search, Credentialing, and Privileges
Employers are generally required to check the NPDB for any instances tied to your name when hiring you or re-credentialing you. This doesn’t mean that it will prevent them from hiring you or giving you privileges. They’ll likely consider patterns, severity of infractions, how recently the issues happened, or other things of importance to them.
Expect to answer questions about anything that’s not straightforward. While this may simply just slow down the processes, in some scenarios, the reports may trigger a deeper inspection, review, or requirement for monitoring. In a worst case scenario, it may be the reason they deny you a job or certain hospital privileges.
State Medical Boards
When a state medical board becomes aware of a report to the NPDB, they have a decision to make. They could either treat it as a simple report, or they may feel the need to investigate further or take additional actions to restrict your practice or license. In a worst case scenario, other states with reciprocity may also echo similar restrictions when considering licensing.
Malpractice Coverage
Unfortunately, reports to the NPDB may result in consequences such as increasing your premiums or being denied coverage.
Specialty Societies or Boards
Some societies may decide to suspend or revoke status within the society if the board certified physician has had a restriction or conditional provision that has been placed on their practice; this of course can be problematic as many employers have maintaining specialty board certification as a condition of remaining on medical staff or remaining employed.
Third Party Payers
Medicare, Medicaid, and commercial payers may terminate enrollment of a clinician if there are concerns about their ability to provide quality care, or if there is a history of healthcare or insurance fraud.
What will realistically happen if I’ve been reported to the NPDB?
There is not a one size fits all answer to this question, as different instances have different consequences, and different entities may take the reports more or less seriously. Things like a single malpractice settlement or a minor administrative rebuke are less likely to cause a major impact on your overall career, whereas a revocation of privileges (or resigning privileges while you’re under investigation), multiple malpractice lawsuits, or suspension of your medical license are more likely to raise significant red flags that may make it harder to get a job or practice medicine.
Know that as many physicians are involved in malpractice lawsuits and settlements, many physicians end up with a report to the NPDB. Again, it’s the more unusual or egregious activities, or abnormal patterns, that typically cause problems.
Employers (or potential employers) will generally try to put your record into context. If something happened a long time ago and was relatively minor, it’s much more likely that they will overlook it. They’re really looking for patterns that indicate that there may be issues in the future, and looking for an explanation or context that is comforting to them. You’ll want to be upfront and honest about what happened, and take attorney advice when appropriate to protect yourself.
How do you know if you’ve been reported to the NPDB?
Often, the person or entity reporting you may let you know that you will be reported as part of their protocol. However, once a report has been filed, you will receive formal notice so that you can review the report and contest anything that is inaccurate.
What should I do after I’ve been reported to the NPDB?
You should take this seriously. Do not ignore it simply because you knew it was coming, as what you think is on the report may be different from what is actually reported. These are some steps to follow based on the recommendations within our physician community:
Review the report, ideally alongside your attorney
You’ll want to ensure that the report reflects what happened accurately and in a way that is as favorable to you as possible. Depending on who filled it out and their feelings about you and the incident, the wording may make it seem better or worse than it was. Taking the advice of a healthcare or employment attorney experienced in these matters is critical, as they will know what may trigger red flags and what will be less likely to impact your career. Especially if the report is about investigations about you or revocation of your privileges or license, the added insight from the attorney could be well worth the investment to avoid or help with future issues.
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Consider a response or dispute
You are able to add a statement to your report that provides additional information or context you’d like included in the report. You’ll want a clear response that is professional and doesn’t make it seem like you’re on the defensive. It is important for potential employers or others to hear your side of the story as well.
According to the NPDB website, “At any time, the subject of a report may dispute the report and enter the report into Dispute Status to disagree with either the factual accuracy of the report or whether the report was submitted in accordance with NPDB reporting requirements. Once the report has been entered into Dispute Status, the subject of a report may choose to take no further action, withdraw the report from Dispute Status, or elevate the report to Dispute Resolution. Entering the report into Dispute Status does not trigger a review of the report by the NPDB.
You must contact the reporting entity and attempt to resolve the dispute directly. Once a report is placed in dispute, the reporting health care organization can correct the report, void the report, or choose to leave the report unchanged. If after 60 days you have received no response from the reporting entity, or you are unsatisfied with the response you received, you can elevate the case to Dispute Resolution.”
Take steps to avoid similar things from happening again
While so much is beyond our control, if there was something you did wrong or could’ve done differently, take steps to change it. As we said, people reviewing these reports are looking for patterns, and knowing it was an isolated event is likely to bring comfort and make it less likely to impact your career.
Conclusion
Getting reported to the National Practitioner Data Bank (NPDB) can rightfully trigger a lot of anxiety. It’s a part of your permanent record and should be taken seriously. That said, understand that a single event is not likely to be career ending unless it was a major issue, and that you can (and should) take steps to protect yourself from the consequences of the report. Consulting with a qualified healthcare attorney can help you navigate this unfortunate situation for the best possible outcome.
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