Appealing NPDB Reports
Physicians must be aware that a full reporting of all adverse events, whether malpractice awards/settlements, license restrictions, hospital privilege issues, or insurance payor terminations, are set forth in a semi-public and centralized database known as the National Practitioner Data Bank (NPDB). A physician’s NPDB report must be treated as a credit report, checked regularly, and its contents appealed where appropriate.
How the NPDB Works
A searchable database of adverse actions taken against physicians has existed in some form since 1986, pursuant to the Health Care Quality Improvement Act. The NPDB assumed its current form in 2013 when two other databases merged. It contains information about the following adverse actions taken against a physician:
Judgments against the physician in civil and criminal court
Restrictions, suspensions, or revocation of medical license
Loss or restriction of clinical privileges at a hospital
Loss of membership in a professional organization
Disciplinary actions by licensing and certification agencies
Loss of eligibility to provide care through Medicare or Medicaid
However, the information in the NPDB is not available to the general public. Only state licensing boards, insurance payors, and hospitals can search for it. The publicly searchable portion of the NPDB contains only anonymized summaries of disciplinary actions taken against physicians in general. Patients cannot tell which physician received which disciplinary action, only that X number of doctors in the state of New York had their licenses suspended in a given year.
Appealing an NPDB Report About You
Unfortunately, a single NPDB report can have drastic and long-lasting ramifications. Indeed, any agency, payor, or hospital that receives a report can (and typically does) commence its own investigation, which can lead to a cascade of subsequent adverse events. Physicians are not without recourse, however. The NPDB website contains an option to dispute reports by submitting a counter-statement to the report. Physicians can also place a report in dispute, triggering an internal appeals process. These challenges are unique to the NPDB system.