National Practitioner Data Bank

The National Practitioner Data Bank began in 1990 as a clearinghouse used to collect and release information related to the professional competence and conduct of health care practitioners. It contains:

1. Disciplinary actions related to the competence or professional misconduct taken against a dentist’s license, including revocation, suspension, censure, reprimand, probation, and licensure surrender;
2. Adverse action reports based upon a dentist’s professional competence or conduct that adversely affects the dentist’s privileges for more than 30 days. These actions include reducing, restricting, suspending, revoking, or denying privileges. It may also include an entity’s decision not to renew a dentist’s privileges if the decision was based upon competence or professional misconduct. It also includes voluntary surrender or restriction of privileges either while under investigation or in lieu of an investigation;
3. Professional society review actions taken for reasons related to competence or professional misconduct that adversely affect membership in the professional society;
4. Professional liability payments made on behalf of a dentist, including any judgment or settlement;
5. Medicare and Medicaid exclusion reports containing sanctions against a practitioner from the Medicare program or the Medicaid program as a result of fraud and abuse;
6. Any registration action taken by the U.S. Drug Enforcement Administration.

The majority of data collected consists of malpractice claims. Information is released only to eligible entities or health care practitioners who wish to conduct self query. By federal law, information is available to hospitals, state licensure boards, some professional societies, and other health care entities under certain circumstances. In limited instances, plaintiffs’ attorneys or plaintiffs representing themselves may query the NPDB. Information contained in the NPDB is not available to the general public. To access information contained in the NPDB, entities must first register with the data bank and follow strict guidelines. There are civil money penalties for those who violate the confidentiality provisions of the Act.

Settlement, even for nuisance value, can have an impact on a practitioner’s record. Because of widespread dissemination of settlement information, it is imperative for practitioners to make sound business decisions when deciding to settle a claim or refund a fee. Once payment is made, the insurance carrier has an obligation to report the payment to the NPDB. Likewise, any dental licensing board that enters some type of censure or sanctions has an obligation to report that to the Data Bank. Such a record can affect licensure, staff privileges, contractual arrangements with health plans, and future insurability for professional liability coverage.

If you have been reported to the NPDB, ensure that the information contained in it is accurate. Reports are routinely mailed to practitioners when they are submitted to the NPDB. There is, however, a procedure for self query to ensure that information is accurate. In addition, there are procedures to amend statements. For specifics regarding NPDB reporting, review, and amending statements, go to www.npdb-hipdb.hrsa.gov.

Anne M. Oldenburg

Oldenburg is a partner at Alholm Monahan Klauke Hay & Oldenburg, LLC in Chicago. She graduated from The John Marshall Law School in 1986 and has defended dental professionals for more than 15 years. She may be reached at [email protected].