National Practitioner Data Bank (NPDB)

During Medical Staff audits, it is not unusual to have National Practitioner Data Bank queries missing in the medical staff files.   Note: Joint Commission has removed specific timeframes as to when the NPDB queries must be performed and have revised the standard to read, the hospital queries the National Practitioner Data Bank (NPDB) in accordance with law and regulation.

It is important to know why this query is required, what laws/regulations apply, and what information the National Practitioner Data Bank collects to keep our patients safe.

The NPDB was established by Congress in 1986 and is a tool that prevents practitioners from moving from state to state without disclosure or discovery of previous damaging performance.  Its mission is to improve healthcare quality, protect the public, and reduce healthcare fraud and abuse in the U.S.

The NPDB operates by the following laws:

  • Title IV of the Health Care Quality Improvement Act of 1986 (HCQIA), Public Law 99-660
  • Section 1921 of the Social Security Act
  • Section 1128E of the Social Security Act

Healthcare organizations, defined by the NPDB as eligible entities, are required to report and/or query to the NPDB.  Eligible entities include hospitalshealth centershealth plansstate licensing and certification authorities, and medical malpractice payers.

Data collected and maintained by the NPDB include the following:

  • Medical malpractice payments
  • Federal and state licensure and certification actions
  • Adverse clinical privileges actions
  • Adverse professional society membership actions
  • Negative actions or findings by private accreditation organizations and peer review organizations
  • Health care-related criminal convictions and civil judgments
  • Exclusions from participation in a Federal or state health care program (including Medicare and Medicaid exclusions)
  • Other adjudicated actions or decisions

To find out how to register your organization with the NPDB and to obtain information about reporting and/or querying, go to the NPDB website (https://www.npdb.hrsa.gov) or to the NPDB Guidebook found under the Resources tab on their website.

Keep your organization safe!

Please contact us for questions or more information at  704-573-4535 or info@courtemanche-assocs.com.

Courtemanche & Associates specializes in Healthcare Accreditation and Regulatory Compliance Consulting Services. With over 29 years of being in business and 100+ years of healthcare experience amongst our consulting team, we are ready to assist with your accreditation and regulatory compliance needs.

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