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.
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. |