The National Practitioner Data Bank: What Healthcare Compliance Officers Need to Know

The National Practitioner Data Bank: What Healthcare Compliance Officers Need to Know
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Patient safety is the backbone of healthcare and the National Practitioner Data Bank (NPDB) plays a critical role in protecting patients from unfit, excluded practitioners.  The NPDB serves its mission to promote quality healthcare and protect patient safety by operating as a reliable workforce tool for users engaged in credentialing, licensing and hiring decisions.

The NPDB currently serves as a repository of adverse information about healthcare providers in the U.S.  Prior to May 6, 2013, there were two federal databanks: the NPDB and the Healthcare Integrity and Protection Data Bank (HIPDB). The HIPDB was created to combat healthcare fraud and abuse to promote quality care. It alerted users that the practitioner, provider or supplier queried should be further examined. Today, the two have merged to become the NPDB to provide authorized users critical, up-to-date information regarding the practitioner’s status to safely perform or work with patients.

In a survey conducted by the NPDB in Synergy, the official magazine of the National Association Medical Staff Services (NAMSS), nearly one-third of the respondents stated they received information from the Data Bank that they did not receive from any other source, demonstrating the importance of the NPDB as a component of the background screening process. 

Improving patient safety and the quality of care should always be a top priority. Here are a few answers to common questions about the NPDB and how the Data Bank can serve as a useful tool to safeguard your patients and staff alike.

Why is the NPDB important?

The Data Bank can reveal a history of adverse actions that could affect patient safety and care. “The NPDB is a critical tool for medical staff services when considering the granting of privileges to a healthcare provider,” says Frank Pierce, PreCheck’s Principle Consultant for Sanction Screening. “Not only does it report sanctions and exclusions, but it also reports past board actions and medical malpractice histories.”

As interpreted by the Office of Inspector General (OIG), the law prohibits healthcare organizations from hiring, contracting with, or arranging for excluded individuals or entities to perform administrative, managerial or volunteer services related to items or services payable by federal healthcare programs. For example, if a hospital contracts with a staffing firm for services provided by an excluded practitioner and paid by federal healthcare programs, the hospital will be subjected to repayment and civil monetary penalties (CMPs).

What information is collected?

The Data Bank collects and compiles specific and important information (e.g., medical malpractice payments, adverse licensure actions including revocation and suspension, adverse clinical privileging action, healthcare related criminal convictions) about medical practitioners that hospitals and other healthcare entities are authorized by law to query. Organizations that must report adverse information about healthcare practitioners to the Data Bank include hospitals, state licensing boards, medical malpractice payers, peer review organizations and private accreditation organizations.

Who can access or query the NPDB?

Access to the information in the Data Bank is limited and is not available to the general public. It is provided to hospitals and other healthcare entities (with formal peer review), professional societies, state healthcare practitioner licensing and certification authorities (including medical and dental boards), and agencies or contractors administering federal and state healthcare programs. The Data Bank is prohibited by law from disclosing information on a specific practitioner, provider or supplier to a member of the general public. However, persons or organizations can request information in a form that does not identify any particular organization or practitioner.

Is searching the NPDB part of your background screening process? Contact us today to see how our background screening and exclusion checking solutions can safeguard your organization.

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