What is the NPDB?

I. What is the NPDB

The National Practitioner Data Bank (NPDB) was created as part of the Health Care Quality Improvement Act of 1986 (HCQIA). This legislation was intended, in part, to establish a database of medical malpractice payments, State licensure board actions, negative peer reviews / clinical privilege determinations, and certain other adverse actions taken against health care practitioners, providers, and suppliers. The NPDB currently contains more than 1.6 million reports. In 2020, more than 65,000 new reports  were submitted to the database.

II. Who Has Access to the NPDB?

The general public does not have access to provider-specific information stored in the NPDB. By law, access is restricted. The primary entities with access to the NPDB include:

• Hospitals and certain other health care entities (including professional societies).
• Quality Improvement Organizations (QIOs).
• State Licensing boards and certification authorities.
• Federal and State law enforcement agencies.
• Federal and state agencies administering or supervising the administration of government health care programs.
• Federal agencies responsible for the licensing and certification of health care practitioners, providers, and suppliers.
• Health plans.
• Health care practitioners, entities, providers, and suppliers requesting information reported to the NPDB concerning themselves (i.e., only self-queries are permitted).

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III. What are the Potential Penalties if an Entity Fails to Comply with the NPDB’s Reporting Requirements?

The penalties and sanctions that may be assessed for failure to comply with the NPDB’s reporting requirements vary. For example:

• Malpractice payers (such as insurance companies) who fail to report medical malpractice payments are subject to Civil Money Penalties of up to $23,331 for each non-reported payment.
• Hospitals or other healthcare entities that fail to report adverse actions can be cited in the Federal Register and can lose their immunity from liability under Title IV with respect to professional review activities for a period of 3 years.
• State Medical or Dental Boards that fail to submit reports of adverse actions can have responsibility to report removed by the Secretary of HHS.
• Professional societies that fails substantially to report adverse membership actions can lose immunity protections under Title IV for 3 years.
• Health plans that fail to report information on an adverse action required to be reported to the NPDB shall be subject to a civil money penalty of up to $39,811 for each adverse action not reported.

The Secretary of HHS is required to publish a public report that identifies government agencies that have failed to report information on adverse actions, such as exclusion from participation in Federal health benefits programs.

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IV. Does NPDB Include all Federal and State Exclusion Actions?

Maybe. Unfortunately, the reporting criteria used to determine whether an excluded individual is listed on the NPDB are different than the reporting criteria used by the Office of Inspector General (OIG) on its “List of Excluded Individuals / Entities” (LEIE).

As the NPDB Guidebook notes:

“The NPDB is meant to be used as one of many tools available to health care entities of all types as they make licensing, certification, hiring, credentialing, contracting, and similar decisions. The NPDB can provide valuable background information, but health care entities should use the NPDV in conjunction with other resources when making personnel and contracting decisions.”

V. Best Practice: Contact the Screening Professionals at Exclusion Screening

In light of the significant limitations of the NPDB discussed above, it cannot be used by Medicare and Medicaid participants to meet their statutory screening obligations. For a cost-effective, easy way to screen your employees, contractors, vendors, and agents, reach out to us today at 800 294-0952 or by filling out the form below.

Frequently Asked Questions

Debarments and Suspensions

Why should Providers Not Rely on the NPDB for Exclusion Screening?

Providers should not rely on the National Practitioner Database for initial background checks or monthly exclusion screening. A 2013 investigation by Public Citizen (PC) found that searches conducted on the NPDB may fail to provide information about OIG exclusions due to incomplete information. Specifically, physicians who were excluded on the LEIE for licensure actions did not have corresponding state licensure reports in the NPDB.

PC did an analysis of providers who were excluded under Section 1128(b)(4) of the Social Security Act and found that 86 percent of the exclusion reports did not have a corresponding state licensure report on the NPDB. Only 58 of the reports disclosed, or 13.9%, matched an NPDB query.[1] This inquiry was based on a total of 417 OIG excluded providers. 

The Health Resources Administration (HRSA) reviewed PC’s data and found that many states do not report “impaired” practitioners to the NPDB, which is likely why the state licensure reports are missing.

OIG seemed to recognize the deficiencies in the NPDB when it warned the industry against conducting exclusion screening based on the NPDB. OIG instead suggested that providers conduct monthly exclusion searches on the OIG-LEIE.

To read more about the necessities of screening, visit Why is it Necessary to Screen Against the NPPES and its NPI Registry Database? 

[1] Alan Levine, et al., Problem with Office of Inspector Gen. Exclusion Reports Jeopardize Provider Background Checks, Public Citizen (June 4, 2013), http://www.citizen.org/documents/2132.pdf.