September 24, 2021

Volume XI, Number 267

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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.

©2021 Norris McLaughlin P.A., All Rights ReservedNational Law Review, Volume XI, Number 208
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About this Author

David Vozza Healthcare Attorney Norris McLaughlin
Member

David N. Vozza devotes his practice to the areas of healthcare and litigation. David’s practice focuses on defending health care professionals in connection with disciplinary and regulatory actions before federal and state agencies, private and government payor audits, civil and criminal fraud investigations, hospital and privileges disputes, and general healthcare litigation in both the federal and state courts.

David regularly defends health care professionals before the Office of Professional Medical Conduct and Office of Professional Discipline.

David also frequently...

917-369-8867
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