Who has Access to National Practitioner Data Bank (NPDB) Reports?
As you know a myriad of disciplinary, malpractice related and other matters must be reported to the NPDB. The number of matters that must be reported are daunting. Here are just some of them.
List of Matters Reported (Partial)
- Medical malpractice payment information
- Licensure actions by boards of medical examiners
- Licensure and certification actions taken by states
- Adverse actions taken by health care entities against clinical privileges, including professional review actions taken by professional societies
- Negative actions or findings by peer review organizations or private accreditation entities
- Health care-related criminal convictions when reported by federal agencies or health plans
- Health care-related civil judgments when reported by federal agencies or health plans
- Exclusions from participating in federal or state health care programs when reported by federal agencies or health plans
- Other health care-related adjudicated actions or decisions when reported by federal agencies or health plans
Once a matter is reported it spreads like a wild fire. Here are some of the ways it spreads.
California Business & Professions Code section 3047
a) The board shall develop an interface with the National Practitioner Data Bank for the purpose of conducting inquiries on applicants for licensure, applicants for renewal of licensure, and current licensees.
(b) The board shall limit its inquiries to both of the following:
(1) Whether an applicant or current licensee has been subject to discipline.
(2) Whether an applicant or current licensee has been the subject of an action required to be reported to the National Practitioner Data Bank by federal law.
(c) On and after July 1, 2018, the board shall charge, in addition to the fees in Section 3152, an applicant for licensure and an applicant for renewal of licensure four dollars ($4) for the purposes of this section
Proactive Disclosure Service (PDS)
The “Continuous Query” is a database function that feeds NPDB filings to entities that hire or credential physicians. It is a 24/7 system that provides information from the data bank database regarding adverse licensure, privileging, Medicare/Medicaid exclusions, civil and criminal convictions, and medical malpractice payments. The entity signs up and enrolls all associated practitioners and the feed is then automatic.
Mandatory Inquiries
Hospitals
Hospitals are mandated by federal law to query the NPDB. Every two years a hospital must request information from the NPDB for all physicians, dentists, and other health care practitioners who are on its medical staff or who hold clinical privileges at the hospital. They also must make the inquiry when privileges are first applied for. Residents or Interns who are not members of medical staff escape this mandatory review.
Privilege Expansion
A request to expand or add privileges triggers a mandatory inquiry by the hospital.
Other Entities Having Access
Health Care Entities Other than Hospitals
Other health care entities can access the data bank when they are entering into employment and more generally affiliation relationships with a doctor.
Federal
Law Enforcement ncluding both state and federal. Agencies including both federal and state agencies administering government health care programs, including private entities administering such programs under contract..
If you are facing NPDB reporting obtain legal assistance as soon as possible so that you have the opportunity to close the barn door before it is too late. Our medical lawyers are expert in protecting physicians.