National Practitioner Data Bank Aims to Reduce Malpractice

In 1986, Congress established the National Practitioner Data Bank (NPDB) with the goal of “improving health care quality, protecting the public, and reducing health care fraud and abuse in the US.”¹

Previous attempts to create this type of database had been unsuccessful.

Before its creation “physicians who had restrictions placed on their practices by some state boards could continue the conduct that had gotten them into trouble by moving to other states.”²

Practitioners had been able to leave behind the record of inadequate services provided to patients and move to other states, where new employers had no knowledge of their previous medical malpractice. This furthered the need for a reporting database of health care malpractice. It is worth noting that database coverage encompassed health professionals in many categories, including pharmacists.

Once the database had been established, criteria were created by the NPDB to guide health care entities about the information that must be reported. Only a select few could access information about adverse clinical privilege actions, adverse professional society membership actions, exclusions from participation in a federal or state health care program, federal and state licensure and certification actions, health care–related civil judgments and criminal convictions, medical malpractice payments, negative actions or findings by private accreditation organizations and peer review organizations, and other adjudicated actions or decisions. Those who could access such information included health plans, hospitals, medical malpractice payers, other health care entities, and state licensing boards.¹

Many may wonder whether the public is granted access to the information compiled by the NPDB. The information that is reported on the NPDB is confidential and cannot be disclosed unless stated by NPDB governing statutes (Title VI, Section 1921, and Section 1128E).

Those allowed access to the information provided on health care practitioners can only “disclose the information to others who are part of an investigation or peer review process, as long as the information is used for the purpose for which it was provided,” according to the NPDB.¹

Although many would want the accessibility of reports to expire after a certain time, the question of how long these reports remain is important because it could alter the extent to which the NPDB is fulfilling its mission.

“Reports in the NPDB do not expire. Information reported to the NPDB is maintained permanently, unless it is corrected or voided from the NPDB by the reporting entity or by the NPDB as a result of [the] dispute resolution process,” according to the NPDB.¹

This is important because practitioners are seen to be held accountable permanently.

Many practitioners subject to the reports, however, not only disagree with them, but also may find them inaccurate. The NPDB allows individuals to dispute reports if they find themselves disagreeing with the claims made. Once the dispute is submitted, the NPDB may “correct the report, void the report, or choose to leave the report unchanged.”¹

Practitioners who are not satisfied with the outcome of a dispute can advance to dispute resolution.

The secretary of the US Department of Health and Human Services is asked to review this report once dispute resolution is initiated.

It seems that, overall, the mission statement is satisfied, but can the NPDB be truly effective? It isno secret that wrongdoings can be covered up. So are practitioners able to avoid reporting?

According to the Harvard Journal on Legislation, “Several techniques to escape reporting to the NPDB have been developed and reported in the literature, including (1) corporate shielding, (2) paying verbal demands for malpractice injury, (3) paying out of pocket without liability insurance, (4) refunding money paid for medical care, (5) precomplaint mediation, and (6) some other statutory schemes.”³

It is difficult to determine the extent to which these escape techniques are practiced, but they are nonetheless still possible.

The information available in the NPDB creates a safer environment for the public because the select entities can access information about a particular practitioner, creating an opportunity to construct an insightful and rational decision about whether, for example, they should hire a particular health care practitioner who is seeking clinical privileges. Although reports can be circumvented in a variety of ways, this may bring about future legislation to further limit the extent to which reports can be avoided.

The process of filing a dispute also allows practitioners to disagree if they find themselves firmly opposing the report. Although some may think
the public is not knowledgeable about the medical field and thus form an educated opinion about the reports accessed, Congress may deem it fair to allow access to all in the future.

About The Authors

Faith B. Leedy is a finance major at the University of Kentucky College of Business and Economics in Lexington.

Joseph L. Fink III, JD, DSC (hon), BSPharm, FAPhA, is a professor of pharmacy law and policy and the Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky College of Pharmacy in Lexington.

References

1. National Practitioner Data Bank. NPDB Guidebook. Updated October 2018. Accessed June 9, 2022. https://www.npdb.hrsa.gov/ resources/aboutGuidebooks.jsp

2. Jesilow P, Ohlander J. The impact of the national practitioner data bank on licensing actions by state medical licensing boards. J Health Hum Serv Adm. 2010;33(1):94-126.

3. Maliha G. The distortive effect of the national practitioner data bank on medicalmalpractice ligation and settlement. Harvard J Legis. 2019;56(1):287-309.