The reports collected apply to health care practitioners, health care entities, providers and suppliers based on the laws and regulations that govern the National Practitioner Data Bank (NPDB).
Table 1. Actions Reportable to the NPDB| Legislation | Who Reports? | What Information is Reported? | Who is Reported |
|---|
| Title IV | Medical malpractice payers, including self-insured hospitals and other health care entities | Medical malpractice payments made for the benefit of a health care practitioner resulting from a written claim or judgment. (Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of a payment) | Practitioners |
| State Medical and Dental Boards | Certain adverse licensure actions related to professional competence or conduct. (Medical and dental boards that meet their reporting requirements for Section 1921, described below, will also meet their requirements to report under Title IV.) (Reports must be submitted to the NPDB within 30 days of the action) | Physicians and dentists |
| Hospitals Other Health Care Entities with formal peer review | Professional review actions - based on reasons related to professional competence or conduct - adversely affecting clinical privileges for a period longer than 30 days. Voluntary surrender or restriction of clinical privileges while under, or to avoid, an investigation. (Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of the action) | Physicians and dentists Other practitioners (optional) |
| Professional societies with formal peer review | Professional review actions, based on reasons relating to professional competence or conduct, adversely affecting membership. (Reports must be submitted to the NPDB and appropriate State Licensing Board within 30 days of the action) | Physicians and dentists Other practitioners (optional) |
| Drug Enforcement Administration (DEA) | DEA controlled substance registration actions* (Reports must be submitted to the NPDB within 30 days of the action) | Practitioners |
| Department of Health and Human Services (HHS) Office of Inspector General | Exclusions from participation in Medicare, Medicaid, and other Federal health care programs* (Exclusions are reported to the NPDB monthly) | Practitioners |
| Section 1921 | Peer review organizations | Negative actions or findings by peer review organizations (Reports must be submitted to the NPDB and appropriate State Licensing or Certification Authority within 30 days of the action) | Practitioners |
| Private accreditation organizations | Negative actions or findings by private accreditation organizations (Reports must be submitted to the NPDB and appropriate State Licensing or Certification Authority within 30 days of the action) | Health care entities, providers, suppliers |
| State Licensing and Certification Authorities | State licensure and certification actions (resulting from formal proceeding)- Adverse actions (including but not limited to revocation, suspension, reprimand, censure, probation)
- Any dismissal or closure of the proceedings by reason of surrendering the license or certification agreement or contract for participation in a government health care program or leaving the state or jurisdiction
- Any other loss of - or loss of the right to apply for or renew - a license or certification agreement or contract for participation in a government health care program
- Any publicly available negative action or finding
(Reports must be submitted to the NPDB within 30 days of the action) | Practitioners, health care entities, providers, suppliers |
| State law enforcement agencies** State Medicaid Fraud Control Units** State agencies administering or supervising the administration of a state health care program** | Exclusions from participation in a state health care program Health care-related civil judgments in state court Health care-related state criminal convictions Other adjudicated actions or decisions (related to the payment, provision, or delivery of a health care item or service) (Reports must be submitted to the NPDB within 30 days of the action) | Practitioners, providers, suppliers |
| Section 1128E | Federal Government agencies Health plans | Federal licensure and certification actions***
- Formal or official actions (including but not limited to revocation, suspension, reprimand, censure or probation)
- Any dismissal or closure of the proceedings by reason of surrendering the license or certification agreement or contract for participation in a government health care program or leaving the state or jurisdiction
- Any other loss of - or loss of the right to apply for or renew - a license or certification agreement or contract for participation in a government health care program
- Any publicly available negative action or finding
Health care-related civil judgments in Federal or state court Health care-related criminal convictions in Federal or state court*** Exclusions from participation in a Federal health care program*** Other adjudicated actions or decisions (related to the payment, provision, or delivery of a health care item or service) (Reports must be submitted to the NPDB within 30 days of the action.) | Practitioners, providers, suppliers |
* This information is reported to the NPDB under Title IV based on a Federal cooperative agreement.
** The NPDB regulations define "state law or fraud enforcement agency" to include but not be limited to these entities. The information that is reported by each entity may differ by state depending on the state structure.
*** Reported only by Federal Government agencies.
FAQs
Hospitals. Hospitals are the only health care entities mandated by federal law to query the NPDB.
Which of the following are required by law to query the NPDB? ›
Hospitals. Hospitals are the only health care entities mandated by federal law to query the NPDB.
What are the three laws that govern NPDB? ›
The NPDB operates by the following laws:
- Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660.
- Section 1921 of the Social Security Act.
- Section 1128E of the Social Security Act.
We receive notifications of outcomes, and we have found that not all settlements have been reported. Are we responsible for reporting? The entity that makes a payment for the benefit of the practitioner in the settlement of a Malpractice Claim is legally responsible for submitting a Report to the NPDB.
Who can the National Practitioner Data Bank disclose information to? ›
The confidentiality provisions of 45 CFR Part 60 allow an eligible entity receiving information from the NPDB to disclose the information to others who are part of the same investigation or peer review process, as long as the information is used for the purpose for which it was provided.In those instances, everyone ...
What you must report to the NPDB? ›
What You Must Report to the NPDB
- Medical malpractice payments.
- Federal and state licensure and certification actions.
- Adverse clinical privileges actions.
- Adverse professional society membership actions.
- Negative actions or findings by private accreditation organizations and peer review organizations.
If, as a result of a professional review action related to professional competence or conduct, a proctor is required in order for a physician or dentist to proceed in freely exercising clinical privileges, and the period lasts longer than 30 days, the action must be reported to the NPDB.
What is the purpose of NPDB? ›
The NPDB is an information clearinghouse created by Congress with the primary goals of improving health care quality, protecting the public, and reducing health care fraud and abuse in the United States.
What steps can be taken to avoid an NPDB report? ›
PURSUE DUE PROCESS
Professional review actions taken by hospitals, health care entities, or professional societies that result in NPDB reports will typically allow some due process rights under the bylaws. A practitioner should access these rights to prevent a report in the first place.
What is NPDB self-query? ›
The Self-Query service searches to see if the information that you provided in the Self-Query order form matches information in reports previously submitted to the NPDB. The Self-Query response shows the results of that search.
Licensed Health Care Practitioners who are reportable in the NPDB include chiropractors, dental health practitioners, dieticians, emergency medical technicians, eye and vision practitioners, nurses and nurses aids, pharmacists and pharmacy practitioners, physicians and physician assistants, podiatrists, psychologists, ...
How do I respond to a NPDB report? ›
There are two ways to respond to a report.
- Enter a statement. You, as the subject of a report, may add a subject statement to a report at any time. ...
- Dispute a report.
The general public does not have access to NPDB information and cannot view your report. However, registered health care organizations that meet federal requirements may query the NPDB to receive report information on health care professionals.
What are the limitations of the NPDB? ›
Federal legislation restricts access to the NPDB to registered entities that meet certain criteria only. The general public does not have right of access to the NPDB or the reports stored in the system. The NPDB is used only for the NPDB's mission of protecting the public and providing quality health care.
What are the three laws that govern NPDB operations? ›
These payments and actions are required to be reported to the NPDB under Title IV of Public Law 99-660, the Health Care Quality Improvement Act of 1986 (Title IV); Section 1921 of the Social Security Act (Section 1921); Section 1128E of the Social Security Act (Section 1128E); and their implementing regulations found ...
Can NPDB reports be shared? ›
Information reported to the NPDB is confidential and shall not be disclosed except as specified in the NPDB regulations. The HHS OIG has the authority to impose civil money penalties on those who violate the confidentiality provisions of NPDB information.
What are the three main items that are reported from the NPDB? ›
Medical Malpractice Payment Report (MMPR), for reporting medical malpractice payments. Judgment or Conviction Report, for reporting health care-related criminal convictions and civil judgments in federal or state court. Adverse Action Report, for reporting all other actions required to be submitted to the NPDB.
Which of the following are laws that regulate the collection and use of personal data? ›
California Consumer Privacy Act (CCPA) | State of California - Department of Justice - Office of the Attorney General.
What was the legislation that mandated the collection of national data on legal actions against health care providers? ›
1986 – The Health Care Quality Improvement Act
President Ronald Reagan signs Title IV of Public Law 99-660, the HCQIA, which led to the National Practitioner Data Bank's (NPDB) establishment.
Which of the following laws created the healthcare integrity and protection data bank? ›
The Healthcare Integrity and Protection Data Bank (HIPDB) was established by the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, (HIPDB's authorizing statute is also referred to as Section 1128E of the Social Security Act).
