What is the National Practitioner Data Bank and Why Is It Important (002)

As a doctor, nurse, dentist, or other licensed medical professional, you can face serious consequences if your licensing board finds that you have violated the rules or laws that govern your profession. In some cases, disciplinary action against you can result in an adverse report to the National Practitioner Data Bank (NPDB), a confidential database of information available to hospitals and state medical boards. Therefore, having a medical license defense lawyer on your side to defend you in disciplinary proceedings can be critical to protecting your career and your professional reputation. By obtaining legal counsel, you will be better positioned to fight back against the severe sanctions you may face in disciplinary proceedings.

Congress established the National Practitioner Data Bank (NPDB) in 1986 as a data repository maintained by the U.S. Department of Health and Human Services (HHS). The database contains information about medical malpractice payments and certain adverse actions related to healthcare practitioners, providers, and suppliers. The purpose of the database is to prevent health care practitioners from moving from one state to another without disclosure of previous damaging information that could make them a safety risk to the public. 

NPBD information is confidential. Individuals and organizations have access to their personal data. Otherwise, only eligible entities can access or report database information; the data is not available to the public, and the public cannot make reports of information to be included in the database.

Who Reports Information to the NPBD?

Various parties can report information to the NPBD, including the following:

  • Medical malpractice payers;
  • State medical and dental boards;
  • Hospital and other health care entities with formal peer review;
  • Professional societies with formal peer review;
  • DEA, the HHS Office of the Inspector General, and other federal government agencies;
  • Peer review and private accreditation organizations;
  • State licensing and certification authorities;
  • State law enforcement agencies;
  • State Medicaid fraud control units;
  • State agencies administering or supervising the administration of state health care programs;
  • Health plans

What Information Does the NPBD Contain?

The NPBD contains substantial adverse information about medical practitioners and providers, including medical malpractice payouts, adverse licensure actions, clinical privilege actions, and professional society membership actions. It also contains DEA-controlled substance registration actions and exclusions from Medicare, Medicaid, and other federal and state healthcare programs. Furthermore, the NPBD contains negative actions or findings by peer review and private accredited organizations and state and federal licensure and certification actions. Finally, the NPBD contains information about healthcare-related civil judgments and criminal convictions in state and federal court. 

Who May Request Information from NPBD?

As mentioned above, only eligible entities and individuals can request information from NPBD. Eligible parties include hospitals and other healthcare entities, professional societies with formal peer review, state medical and dental boards and other state licensing boards, and federal licensing and certification authorities. Agencies administering federal and state healthcare plans, health plans, state law enforcement agencies, and state Medicaid fraud control units also may request information. Depending on the party requesting information and the nature of the information requested, the party may only have limited access to some information maintained by the NPBD. For instance, researchers may request data from the NPBD but can only receive de-identified statistical data. Healthcare practitioners can request information, but only about themselves. 

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Implications of the NPBD for Medical Practitioners

Hospitals are the only healthcare entities required by federal law to query the NPBD regarding medical practitioners. More specifically, federal law requires hospitals to search the NPBD whenever a physician, dentist, or other health care practitioner applies for medical staff appointment or clinical privileges and every two years after that. As a result, any hospital to which you apply for a medical appointment or clinical privileges will necessarily access any adverse findings, orders, convictions, etc., reported to NPBD at one point or another. Therefore, you likely will be unable to avoid disclosure of these items, even if they occurred in another state.

Furthermore, although hospitals are not required to query the NPBD on any staff other than physicians and dentists, they can query other healthcare practitioners when making employment or affiliation decisions. As a result, hospitals and healthcare entities may query the NPBD when hiring nurses, nurse’s aides, radiological technicians, physical therapists, and other types of healthcare practitioners. 

While disciplinary activity for doctors is a matter of public record in Texas, the NPBD allows these records to follow doctors out of state. However, it is worth noting that if doctors are acquitted of all misconduct allegations in disciplinary proceedings before the Texas Medical Board (TMB), the TMB must remove its adverse report from the NPBD. 

Last year, in Van Bowen v. TMB, the Texas Supreme Court ruled the TMB was required to void its initial report of a temporary sanction against a physician after he was exonerated of all wrongdoing following a hearing before an administrative law judge hearing. The court found that it was insufficient for the TMB to revise its initial NPBD report, rather than void it under the circumstances. 

Bertolino, LLP: A Law Firm Who Will Stand Up to the TMB to Defend Your Medical License 

When a complaint threatens your ability to earn a living, you should not delay retaining a seasoned medical license defense attorney to represent your interests. The sooner you contact us about your healthcare insurance fraud or other disciplinary matter, the sooner we can start working on your case. Contact the lawyers of Bertolino LLP today by calling (512) 515-9518 or visiting us online

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