The National Practitioner Data Bank (NPDB) is a digital database of information about adverse medical events, the practitioners involved in the event, and payments for medical malpractice that may have resulted. Created in 1986, the purpose of the NPDB is to centralize information about medical errors, negligence, and malpractice in order to reduce healthcare fraud and abuse.
Generally speaking, NPDB reports are not publicly available. However, the information contained in these reports—including data about medical malpractice payments—is available to healthcare entities, like medical malpractice payers, healthcare plans, hospitals, licensing agencies, and state boards. Practitioners may also view their own NPDB reports. However, the NPDB does release some critical data that can be accessed by the public, namely reports of the number of malpractice incidents and payments by state and practitioner status. The NPDB Data Analysis Tool allows users to run reports on this data, generating insights into how medical malpractice awards are distributed across the country.
When an adverse event is reported and the practitioners is found liable for medical malpractice related to that event, what needs to be reported to the NPDB? This article provides an overview.
What Information Does the NPDB Collect?
The National Practitioner Data Bank collects reports about health care practitioners, health care entities, providers, and suppliers who are involved in any of several different types of situations. Information collected (and reports generated) by the NPDB include:
- Adverse actions regarding a practitioner’s clinical privileges or professional society memberships,
- Adverse actions and/or negative findings from private accreditation and peer review organizations,
- Exclusion from participating in federal or state healthcare programs, including Medicare/Medicaid,
- Actions involving federal and state licensure or certification,
- Other adjudicated actions or decisions (such as a finding of liability for medical malpractice by a judge or jury),
- Medical malpractice payments.
In each category, the NPDB has particular rules about what information must be reported and by which party or parties. In some situations, one party is asked to report on or about another. For instance, a state medical board that takes a reportable action against a physician reports the action and the physicians’ identifying information. The action is added to the physician’s report and may be viewed by the physician, as well as by certain entities with a stake in the physician’s conduct, such as a hospital considering whether or not to extend privileges to that physician.
What Payments Must Be Reported to the NPDB?
Generally speaking, medical malpractice payments must be reported to the NPDB when they are made by, or made on behalf of, a particular individual physician. Payments that are related to a suit or claim against an entity like a hospital, but not against an individual, are not reported.
The NPDB defines “medical malpractice payments” as exchanges of money made as a result of:
- a written complaint or claim,
- alleging damages related to a practitioner providing or failing to provide health care services, that
- demands financial compensation for damages.
This definition covers both money settlements and judgments that follow courtroom verdicts, but it is not limited to claims filed in state or federal court. Claims that go through arbitration are also covered by these rules, and payments made as a result of arbitrated claims must also be reported to the NPDB.
Both lump-sum and periodic payments must be reported. However, the report for periodic payments may be made when the first payment is made. A report for every separate periodic payment is not required.
Who Must Report Payments to the NPDB?
Any entity that makes a payment on behalf of a practitioner must report the payment to the NPDB. Common reporting entities include hospitals and other self-insured health care entities.
When the NPDB was created, practitioners who made payments from their own personal funds had to report those payments as well. However, in 1993, the U.S. Court of Appeals for the D.C. Circuit determined that a practitioner who makes a payment out of their personal funds for their own benefit does not have to report the payment to the NPDB.
If the practitioner is making the payment as part of a business, however—whether a professional corporation or as a sole practitioner—then he or she must report that payment to the NPDB.
All payments must identify a specific practitioner to whom they relate. For instance, a lawsuit for medical malpractice may name a particular doctor or nurse. Any payments made in the lawsuit that are related to that doctor’s or nurse’s conduct must be reported to the NPDB with that doctor’s or nurse’s name attached.
The NPDB has detailed rules for reporting payments in a number of settlement situations, including subrogation, high-low agreements, and other plans. To learn more, visit the NPDB website at npdb.hrsa.gov.