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Ericka L. Adler, JD, LLM has practiced in the area of regulatory and transactional healthcare law for more than 20 years. She represents physicians and other healthcare providers across the country in their day-to-day legal needs, including contract negotiations, sale transactions, and complex joint ventures. She also works with providers on a wide variety of compliance issues such as Stark Law, Anti-Kickback Statute, and HIPAA. Ericka has been writing for Physicians Practice since 2011.
Here's a primer on medical liability payment data contained in the National Practitioners Data Bank (NPDB) and why it is important for physicians .
Most providers have heard of the National Practitioners Data Bank (NPDB), but are not entirely familiar with exactly what it is or how it operates. The NPDB is an electronic depository of all payments made on behalf of physicians in connection with medical liability settlements, and judgments. The NPDB also tracks adverse actions against a practitioner’s license, clinical privileges, and professional society memberships. It is required by federal law that information on medical liability payments and certain adverse actions be reported to the NPDB, and the NPDB is further required by law to make this information available to hospitals, state licensure boards, and other healthcare entities.
Physicians can be impacted greatly by reports made to the NPDB. This is especially true when an NPDB report is made available to hospitals, licensure boards, and professional societies when physicians request staff privileges, licensure, and other types of appointments. Unfortunately, whether the NPDB report is evidence of a physician’s qualifications or quality, the report immediately puts everyone on notice of potential competence or professional misconduct results.
It is extremely important that physicians be aware that adverse events in which they are involved may be reported to the NPDB. For example, if a physician is involved in a malpractice case and the employer or the carrier wants to settle the case, even if the case has no real merit, payment of a settlement can lead to a NPDB report. It is important to remember that an attorney appointed by the malpractice carrier to defend the physician is not necessarily representing the interest of the physician and, if the carrier or employer prefers, will settle a case to avoid further expense or for other reasons. This decision may be opposed by the physician, but may have little say. For these reasons, it is always in the physician’s best interest to retain personal counsel, because any settlement payment will be reportable to the NPDB.
When a physician is involved in a licensure or a loss of medical staff privileges action, there are strategies that can avoid a result requiring a report to the NPDB. For this reason, it is very important to use experienced counsel to handle any type of interaction that could result in a reportable event. Reportable events also include voluntary surrender or restriction of a license or privileges while under investigation or in lieu of investigation. Legal advice is also helpful even when a report is to be made, since the parties can often mutually agree on the language that will be reported to the NPDB, which can greatly help clarify the issues and potentially mitigate damage should the report ever be made public. The wording can have a great impact on a subsequent employer or state licensing board.
Finally, every physician should ensure that information contained in the NPDB report is accurate. Reports are routinely mailed to physicians when they are submitted to the NPDB and these reports must be reviewed carefully. If any information in the NPDB appears inaccurate, it can be disputed within 60 days from the date that the report is mailed to the physician. If the information is technically accurate but misleading, the physician does have a right to add his or her own brief statement relevant to the events covered in the actual report and anyone receiving a copy of the report will be able to see the physician’s statement. This explanation, if carefully worded, can also have a great impact on how the NPDB report will understood. Again, it is advisable to always consult an attorney for help in drafting this type of clarification so as to obtain the best possible result.
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