Definition/Introduction

The National Practitioner Data Bank (NPDB) is a centralized database that is overseen by the United States Department of Health and Human Services that pools reports of medical malpractice and other aversive actions taken against health care workers. Information is submitted to NPDB by agencies such as hospitals, state licensing boards, and medical malpractice insurance companies. The records that the NPDB compile are healthcare-related criminal convictions and civil judgments (i.e., medical malpractice), final decisions rendered by licensure and certification actions, and other adjudicated actions rendered. Information contained in the database is utilized to make employment decisions, track a physician's records as well as aid in medical privileging. The records contained in NPDB are protected and only authorized users (i.e., hospitals or state licensure board) considering a physician can obtain the record via a query.[1]

Issues of Concern

The NPDB was created by Congress with the intent to increase patient safety, combat health care fraud, and improve medical care due to the rising amount of Medical Malpractice Litigation. Additionally, the purpose of the NPDB was imposing restrictions on medical health professionals who were deemed incompetent or had a performance that is detrimental to another community from crossing State lines. The NPDB also was an attempt to encourage professional review by peers.

The laws governing the NPDB are:

1. Section 1921 (Passed in 1987) permitting the Federal Government to collect information about licensure sanctions on physicians, health care entities, and dentists.
2. Omnibus Budget Reconciliation Act of 1990 to add the language "any negative action or finding" from entities such as peer review organizations, private accreditation entities, or state licensure regulators.
3. Modified Regulations for Section 1921published in Federal Register on January 28, 2010, to create a national control program to oversee fraud and abuse by health care entities and clinicians. 

The NPDB is not meant to be the sole avenue of verification method of a clinician's credentials and solely a system to aid in determining if a more extensive investigation should take place. An example of where this is applicable is a medical malpractice settlement, which will be displayed in the NPDB; however, settlements of medical malpractice can be made for a variety of different practical reasons and may not be representative of a physician lacking competence or engaging or conduct that did not meet the standard of care. Additionally, one of the critical issues of the NPDB is maintaining the confidentiality, accuracy, and security of the database that is regulated by 45 CFR Part 60. To protect the security and confidentiality of the information, the NPDB  ensures that sensitive financial and personal information is protected from unauthorized users.[2][3]

Clinical Significance

Unfortunately, throughout a clinician's career, they may be subjected to a report that was submitted by a reporting entity such as a malpractice judgment or settlement. This report would follow the clinician for the remainder of the career unless the information submitted were not factually correct. After receiving a report, the NPDB will notify the subject of the report, and advise the clinician on how to obtain the record. Additionally, the NPDB will explain to the clinician named in a record the process to add a statement or the process of disputing the report.[4] 

Additionally, clinicians need to be aware that there are many definitions of reportable events to the NPDB. Since hospitals are required to report a physician resigning while an investigation is undergoing to the NPDB, clinicians should receive in writing that that are not subject to any inquiry before resigning to ensure that they maintain their rights and have a chance to defend their reputation if they are subject to any investigations. Furthermore, clinicians should stay informed about changes to the NDPB throughout there career since the adverse reports can make getting granted or renewing hospital privileges challenging. 

Review Questions

• Access free multiple choice questions on this topic.
• Comment on this article.

References

1.

Berlin J. Under Investigation? Tex Med. 2017 Mar 01;113(3):49-53. [PubMed: 28323319]

2.

Snelson EA. National Practitioner Data Bank: more guidelines, more problems. Med Staff Couns. 1993 Summer;7(3):1-9. [PubMed: 10126797]

3.

Chenen AR. National Practitioner Data Bank Guidebook Supplement. Med Staff Couns. 1993 Spring;7(2):63-8. [PubMed: 10124485]

4.

Ji YD, Peacock ZS, Resnick CM. Characteristics of National Malpractice Claims in Oral and Maxillofacial Surgery. J Oral Maxillofac Surg. 2020 Aug;78(8):1314-1318. [PubMed: 32305375]

Disclosure: Harrison Wermuth declares no relevant financial relationships with ineligible companies.

Disclosure: Shane Sergent declares no relevant financial relationships with ineligible companies.