The National Practitioner Data Bank (“NPDB”) is a confidential 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 U.S. The NPDB is primarily an alert or flagging system intended to facilitate a comprehensive review of the professional credentials of health care practitioners, health care entities, providers, and suppliers.
The NPDB was originally established by Title IV of the Health Care Quality Improvement Act of 1986, Public Law 99-660. The intent of Title IV was to improve the quality of health care by encouraging State Licensing Boards, professional societies, hospitals, and other health care entities to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from state to state without disclosure or discovery of previous medical malpractice payment and adverse action history. These adverse actions include certain licensure, clinical privileges, and professional society membership actions, as well as Drug Enforcement Agency controlled substance registration actions and exclusions from participation in Medicare, Medicaid, and other Federal health care programs.
Information currently collected and disclosed by the NPDB under Section 1921 of the Social Security Act includes state licensure and certification actions against health care practitioners, entities, providers and suppliers; negative actions or findings by peer review organizations and private accreditation organizations; as well as certain final adverse actions taken by state law enforcement agencies, State Medicaid Fraud Control Units, and state agencies administering or supervising the administration of state health care programs. These final adverse actions include exclusions from a state health care program, health care-related criminal convictions and civil judgments in state court, and other adjudicated actions or decisions specified in regulations.
A medical malpractice payment made by an entity such as a medical malpractice insurance company for the benefit of a health care practitioner in settlement or satisfaction, in whole or in part, of a written claim or judgment against that health care practitioner must be reported to the NPDB if the payment meets the following criteria:
1) Must be the exchanges of money;
2) 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);
and
3) The practitioner must be named in both the complaint or claim, and the settlement release or final adjudication.
The NPDB has published the following flowchart to help determine if a medical malpractice payment must be reported to the NPDB:
Because a medical malpractice payment made on behalf of a health care practitioner who was dismissed from the claim or complaint prior to settlement or final adjudication is not reported to the NPDB if the dismissal was not the result of a condition in the settlement or release, medical malpractice plaintiff attorneys may name the employer of the particular health care practitioner who allegedly committed medical malpractice, along with the health care practitioner individually, so that there is an incentive to the medical malpractice defendants to resolve the claim before trial if the individual medical malpractice defendant can be subsequently dismissed from the claim and only the corporate defendant remain as the named defendant, thereby keeping the settlement from being reported to the NPDB against the individual health care practitioner.
In short, just because a health care practitioner’s name does not appear in the NPDB as having had a medical malpractice payment made on his behalf, it does not mean that the health care practitioner was not involved in a medical malpractice claim that resulted in a payment with regard to the claim.
If you or a loved one may be the victim of medical malpractice in the United States, you should promptly contact a local medical malpractice attorney in your state who may be willing to investigate your possible medical malpractice claim for you and file a medical malpractice claim on your behalf, if appropriate.
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