Disputing National Practitioner Data Bank Records

The Affordable Care Act established the National Practitioner Data Bank (NPDB) to centralize information about medical professionals that previously appeared across multiple systems. Launched in May 2013 and managed by the U.S. Department of Health and Human Services (HHS), the NPDB is governed by the following laws:

  • Title IV of the Health Care Quality Improvement Act of 1986
  • The Medicare and Medicaid Patient and Program Protection Act of 1987, Section 1921 of the Social Security Act
  • Health Insurance Portability and Accountability Act of 1996, Section 1128E of the Social Security Act

The NPDB contains the following types of important data:

  • Medical malpractice payments
  • Adverse actions involving licensure or certification
  • Restrictions on clinical privileges
  • Board membership disciplinary actions
  • DEA registration actions
  • Medicare and Medicaid exclusions
  • State or federal law enforcement dispositions
  • Criminal convictions
  • Civil judgments

Eligible entities — including hospitals, state licensing boards, government agencies and health plans — are permitted to report and access the information in the NPDB. Reports can negatively affect a practitioner’s employment opportunities, licensure and specialization certifications.

For this reason medical professionals have the right to refute the accuracy, completeness, timeliness or relevance of their reports, or to add an explanatory comment. Practitioners might conduct a self-inquiry as part of an employment, insurance or license application or wish to see if negative reports exist regarding the care they provide. In addition, a medical professional who is the subject of a report is notified by the agency.

The NPDB suggests that practitioners who do not agree with the report use the following response methods:

  • Submit a statement — Statements made by practitioners become part of the report. They can add or clarify facts, but they cannot edit the information uploaded by the HHS.
  • Dispute a report — A medical professional who refutes information contained in the report can officially dispute the report on the online system.
  • Dispute resolution request — When a medical professional requests a dispute resolution, a manager assigned to the report reviews it based upon the information submitted by all parties.

Health care providers who are the subject of negative NPDB reports might wish to enlist help from an attorney who can challenge the information and set the record straight.

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Posted in: Dispute Resolution & Professional License Defense