What is the National Practitioner Data Bank?
Question: What is the National Practitioner Data Bank (NPDB) and how does it work?
Posted in Risk Management on Friday, January 3, 2020
Answer: Congress enacted legislation leading to the creation of the NPDB to improve the quality of healthcare and provide transparency with respect to malpractice claims and licensure actions.
The NPDB is an electronic repository of all payments made on behalf of providers in connection with malpractice settlements or judgments, as well as adverse peer review actions against licenses, clinical privileges, and professional society memberships of healthcare practitioners.
Insurance Company & NPDB Requirements
By federal law, insurance companies must report all malpractice payments and certain adverse actions to the NPDB (doctors have the opportunity to include a response to the report to share their side of the story with the NPDB). In turn, the NPDB is required to make this information available to state licensing boards, hospitals, and in some situations, professional societies and healthcare entities.
The intent is to improve the quality of healthcare by encouraging state licensing boards, healthcare entities and professional societies to identify and discipline those who engage in unprofessional behavior. The aim of the NPDB is also to restrict healthcare practitioners from moving from state to state without disclosing previous malpractice situations.
DCs who are facing a claim need to be aware that if their case gets settled ... despite the fact that they could have won in court ... their name is reported to the NPDB. And a summary of the allegations, as well as the settlement amount, may be queried by third-party payers, state licensing boards and other entities. Depending on the state, this can lead to a host of consequences, including a loss of credentialing from some networks and a separate professional discipline allegation.
At NCMIC, we've seen how these consequences have impacted doctors over the years. That's why we include our doctors every step of the way during their defense. We make sure they understand all their options and discuss with them the ramifications associated with those options.
For more information about the NPDB, go to their website.