© Gary Inglese

Dental Defense - Illinois Department of Financial and Professional Regulations Defense - Dental-Legal Issues - Dental Risk Management - Dental Contracts and Business Issues - Dental Office Transitions

The data collected by the NPDB falls into two categories:

Payouts for professional liability settlements and adverse actions.  This includes state licensure and certification, clinical privileges/panel membership, professional society membership and Drug Enforcement Agency cases.
US Department of Health and Human Services Office of the Inspector General exclusions.  These include individuals and entities who are excluded from participation in state or federal health care programs due to unlawful and/or fraudulent conduct.

Information collected in the NPDB is used by authorized organizations for the purposes of employment, licensing and credentialing.  The information is confidential and not available to the public.  Subjects of the reports are permitted access their own information.

Entities eligible to query the NPDB for information include hospitals and other health care entities, professional societies, medical and dental licensing boards, health plans, law enforcement agencies and government health care programs.  Reporting agencies include health care entities, hospitals and state licensing and certification agencies.  Reporting agencies include insurance companies that make professional liability payouts. 

In order to be reportable, the claim must meet the following criteria:

• Must involve the exchange of money;
• Must be the result of a written complaint or claim demanding monetary payment for damages (based on the practitioner’s provision of or failure to provide health care services);
  
• The practitioner must be named in both the complaint or claim, and the settlement release or final adjudication.
  

 The following discusses common myths about the NPDB:

Myth:     Reporting is triggered by a certain dollar amount.

Reality:  Any payout made by an insurance carrier on a professional liability issue, irrelevant of the payment amount is reportable under law.

Claims paid out of pocket by individual practitioners are not reportable, as long as they are drawn from the doctor’s personal account, not a corporate or business account.  For this reason, some insured opt to settle low-value claims on their own.

Simply contacting an insurance carrier is not grounds for reporting.  The claim must come to a close, in writing with the insured’s consent.

Myth:     Reporting is optional.

Reality:  All eligible entities are require under law to report professional liability payouts, corrective actions, and license and certification findings.  Not only mandatory, but eligible entities are subject to fines if they fail to report.
 
Myth:     Information contained in the data bank is available to the public.

Reality:  The general public does not have access to the data bank.  Access is only granted to designated entities, such as hospitals, health care companies, licensing boards, professional societies and those administering state or federal health care programs.  All are required to meet certain guidelines and pre-register.

Individual practitioners are allowed to conduct a self-query and healthcare providers can obtain their own records in certain cases.

Myth:     Information in the data bank drops off after a period of time.

Reality:  Information reported to the data bank stays in the data bank indefinitely.

Myth:     Once reported to the data bank, records cannot be changed. 

Reality:  While individuals are not allowed to change their records, the reporting agencies can.  Individuals can respond to reportable actions contained in the date bank.  The NPDB will notify individuals if they are the subject of a report.  

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The National Practitioner Data Bank (NPDB) is an online repository of information pertaining to the professional competence and conduct of health care practitioners.  The NPDB was begun in 1990 because of increasing rates of professional liability claims and to prevent incompetent and sometimes dangerous practitioners from moving from state to state undetected.  The goal of the NPDB is to improve the quality of health care nationwide.  It is operated by the US Department of Health and Human Services.