Disputing Reports and Secretarial Reviews
Topics
- Subject Information in the Data Banks
- Subject Statements
- Subject Disputes
- Secretarial Review
- Secretarial Review Results
- Improper Disputes and Requests for Secretarial Review
Subject Information in the Data Banks
When the NPDB-HIPDB receives a report, the information is processed exactly as it was submitted by the reporting entity. Reporting entities are responsible for the accuracy of the information they report and the Data Banks are prohibited by law from modifying information submitted in reports. When a report is processed, a Report Verification Document is sent to the reporting entity, and a Notification of a Report in the Data Bank(s) is sent to the subject.
Subjects should review the report for accuracy, including such information as current address and place of employment. Subjects may not submit changes to reports. If any information in a report is inaccurate, the subject must contact the reporting entity to request that it file a correction to the report. If the reporting entity does not correct the information, the subject may add a statement or dispute the accuracy of the report. To do this, a subject must initiate a dispute through the Report Response Service.
Reporting entities may reduce the likelihood of a subject disputing a report by consulting with the practitioner, provider, or supplier about the report prior to submitting it to the Data Bank(s).
Subject Statements
The subject of a report may add a statement to a report at any time. When a statement is processed, a notification of the statement is sent to all queriers who previously received the report, and the statement will be included with the report when it is released to future queriers. Subject Statements are limited to 4,000 characters, including spaces and punctuation. Drafting a statement in accordance with the character limits helps to ensure that the statement will contain the information a subject considers most important. Subject Statements must not include any patient names.
A Subject Statement becomes part of the specific report for which it is filed. If the reporting entity subsequently corrects or changes a report that contains a Subject Statement, the original statement will be maintained in the modified report until the subject elects to remove it or replace it with a new statement.
Subject Disputes
The subject of a Medical Malpractice Payment Report, an Adverse Action Report, or a Judgment or Conviction Report may dispute either the factual accuracy of the report or whether the report was submitted in accordance with the NPDB’s or the HIPDB’s reporting requirements, including the eligibility of the entity to report the information to the Data Bank(s). A subject may not dispute a report in order to protest a decision made by an insurer to settle a claim or to appeal the underlying reasons for an adverse action, or judgment or conviction.
When the Data Banks receive a properly completed dispute, notification of the dispute is sent to all queriers who previously received the report, and is included with the report when it is released to future queriers.
A dispute becomes part of the specific report it is contesting. If the report is changed by the reporting entity, the dispute notation attached to the report is maintained until the subject elects to remove it.
There are three possible outcomes for a dispute:
- The reporting entity corrects the report to the satisfaction of the subject.
- The reporting entity voids the report.
- The reporting entity declines to change the report.
Secretarial Review
If the reporting entity declines to change the disputed report or takes no action, the subject may request that the Secretary of Health and Human Services (HHS) review the disputed report. A request for Secretarial Review of a disputed report must be initiated through the on-line Report Response Service. Please note that the dispute and any accompanying documentation must be sent to the Data Banks, not directly to the Secretary.
The subject also must:
- State clearly and briefly in writing which facts are in dispute
and what the subject believes are the facts.
- Submit documentation substantiating that the reporting entity’s
information is inaccurate. Documentation must directly relate
to the facts in dispute and substantially contribute to a determination
of the factual accuracy of the report. Documentation may not exceed
10 pages, including attachments and exhibits.
- Submit proof that the subject attempted to resolve the disagreement with the reporting entity but was unsuccessful. Proof may be a copy of the subject's correspondence to the reporting entity and the entity's response, if any.
Secretarial Review Results
The Secretary will review disputed reports only for accuracy of factual information and to ensure that the information was required to be reported. The Secretary will not review the merits of a medical malpractice claim in the case of a payment or the appropriateness of, or basis for, an adverse action or judgment or conviction.
There are three possible outcomes for Secretarial Review of a dispute:
- The Secretary concludes that the report is accurate.
- The Secretary concludes that the report is inaccurate.
- The Secretary concludes that the issues in dispute are outside the scope of Secretarial Review.
Improper Disputes and Requests for Secretarial Review
Filing a dispute is considered improper when the report in question has been corrected or voided, or is already in dispute. If a subject submits an improper dispute, the Data Banks will send notification to the subject explaining why the report cannot be disputed.
A request for Secretarial Review is considered improper when the report in question has not previously been disputed by the subject practitioner, provider, or supplier. Before requesting Secretarial Review, a subject must first attempt to resolve the disagreement with the reporting entity and then may dispute the report according to the instructions provided on the Notification of a Report in the Data Bank(s) document. If an improper request for Secretarial Review is submitted, the Data Banks will notify the subject that the report must first be disputed.
For more information on disputes and statements, see the Fact Sheet on the Dispute Process , the NPDB Guidebook, and the HIPDB Guidebook.