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Practioner Data Banks
Practioner Data Banks

Practitioner Data Banks

National Practitioner Data Bank

Division of Practitioner Data Banks (DPDB)

The Division of Practitioner Data Banks (DPDB) is responsible for the implementation of the National Practitioner Data Bank (NPDB) and Healthcare Integrity and Protection Data Bank (HIPDB).  The NPDB and HIPDB are alert or flagging systems intended to facilitate a comprehensive review of the professional credentials of health care practitioners, providers, and suppliers.

National Practitioner Data Bank (NPDB)

The National Practitioner Data Bank (NPDB) was established through Title IV of Public Law 99-660, the Healthcare Quality Improvement Act of 1986.  The NPDB began operations in 1990.  The intent of the NPDB is to keep unprofessional or incompetent practitioners from moving from State to State without disclosure or discovery of their previous damaging or incompetent performance.  The NPDB contains information on the following actions against physicians and dentists: (1) adverse licensure actions; (2) clinical privileges actions, and; (3) professional society membership actions. In addition, the NPDB contains the following actions against physicians, dentists and other health care practitioners: (4) paid medical malpractice judgments and settlements; (5) Exclusions from participation in Medicare/Medicaid programs, and; (6) registration actions taken by the U.S. Drug Enforcement Administration (DEA).  The law specifies that NPDB make reported information available to hospitals, health care entities with formal peer review, professional societies with formal peer review, State licensing authorities, health care practitioners (self-query), researchers (statistics only), and in limited circumstances, plaintiffs’ attorneys.  The NPDB is prohibited from disclosing specific information on practitioners to the general public. 

Healthcare Integrity and Protection Data Bank

The Healthcare Integrity and Protection Data Bank (HIPDB) was established under Section 1128E of the Social Security Act as added by Section 221(a) of the Health Insurance Portability and Accountability Act of 1996.  The HIPDB became fully operational in March 2000.  The intent of the HIPDB is to combat fraud and abuse in health insurance and health care delivery.  The HIPDB contains the following types of information: (1) civil judgments against health care providers, suppliers, or practitioners related to the delivery of a health care item or service, (2) Federal or State criminal convictions against health care providers, suppliers, or practitioners related to the delivery of a health care item or service, (3) actions by Federal or State agencies responsible for the licensing and certification of health care providers, suppliers, or practitioners, (4) exclusions of health care providers, suppliers, or practitioners from participation in Federal or State health care programs, and (5) any other adjudicated actions against health care providers, suppliers, or practitioners.  HIPDB information is available to Federal and State Government agencies, health plans, health care practitioners/suppliers (self-query), and researchers (statistics only).  Similar to the NPDB, the HIPDB is prohibited from disclosing specific information on a practitioner, provider, or supplier to the general public.

Proactive Disclosure Service (PDS) Prototype

The Data Banks’ Proactive Disclosure Service Prototype (PDS) went on-line May 1, 2007.  PDS offers health care providers, such as hospitals, managed care organizations, and medical groups the opportunity to continuously query enrolled practitioners. Health care entities who subscribe to PDS will receive notification within 24 hours of the Data Banks’ receipt of a report on any of its enrolled practitioners.

PDS satisfies the credentialing standards of accreditation organizations, and meets the mandatory querying requirements of the Health Care Quality Improvement Act of 1986, as amended.  Health care entities that subscribe to PDS are essentially querying 24 hours a day, 365 days a year.  The PDS is accepted by the Joint Commission, National Committee for Quality Assurance (NCQA), and the Centers for Medicare and Medicaid Services (CMS) as fulfillment of designated accreditation and/or certification standards.

Subscribers have deemed all aspects of PDS as a success — from enrollment to report disclosure notifications.  They are particularly excited that PDS saves time and money when compared to the traditional method of querying the Data Banks.

While the Data Banks will continue to evaluate the PDS functionality and viability over a period of 18 months, entities may subscribe and enroll practitioners at any time during this period and will receive a full year of service, even if their subscription extends beyond November, 2008.

More information about PDS.

Upcoming Initiatives: 

Section 1921

The scope of the NPDB will soon be expanded to include sanctions taken by State and Federal licensing authorities against all health care practitioners and entities.   The United States Department of Health and Human Services is currently drafting regulations to implement Section 1921 of the Social Security Act, as amended by Section 5(b) of the Medicare and Medicaid Patient and Program Protection Act of 1987.  The intent of Section 5(b) is to protect program beneficiaries from unfit health care practitioners, and otherwise improve the anti-fraud provisions of the Medicare and State health care programs. 


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