National Practitioner Data Bank (NPDB)

Types of Reports

The NPDB receives six types of reports: (1) medical malpractice payments made on behalf of a practitioner, (2) licensure actions taken by state medical and dental boards, (3) professional review actions taken by hospitals and other healthcare entities exercising significant peer review activities, (4) professional society membership actions, (5) actions taken by the U.S. Drug Enforcement Administration (DEA), and (6) Medicare and Medicaid exclusions. Medical-malpractice payments are the most common type of report received by the NPDB. Since its inception, the NPDB has received about 320,000 medical malpractice reports, which represent about 75% of all reports. State licensure actions are the next most common type of report, at 14%, followed by Medicare and Medicaid exclusion at 8.0% and clinical privileging actions at about 4%. Professional society membership and DEA actions make up less than 0.5% of all reports in the data bank.

Types of Providers Covered

While the NPDB covers a wide variety of medical practitioners, physicians are those most often reported to the data bank. Physicians make up approximately 70% of all practitioners reported to the data bank. Dentists make up the next largest group, at 13%, followed by nurses and nursing-related practitioners, who account for 9%, and chiropractors, who represent about 3% of those practitioners reported.

Types of Entities Reporting

Just as there are a variety of types of reports in the NPDB, there are also a variety of entities providing those reports. Any entity that makes a medical malpractice payment on behalf of a practitioner for full or partial settlement of a claim or judgment must submit a report to the NPDB. In general, medical malpractice reports are made by insurers or carriers; however, these reports may also be filed by other types of organizations that make such payments. Self-insured hospitals, physician groups, and managed-care organizations can also file reports. State medical and dental boards are required to report state licensure disciplinary actions related to professional competence or conduct. Other professional boards are not required to report to the data bank. Any hospital or other healthcare entity that takes a professional review action that restricts or suspends the clinical [Page 843]privileges of a physician or dentist for more then 30 days must report that action to the NPDB. Physicians and dentists may voluntarily surrender or restrict their clinical privileges while being investigated for possible professional incompetence or improper professional conduct in return for suspension of the investigation. In these cases, the healthcare entity must also file a report. This situation is considered a reportable clinical privileging action. Clinical privilege actions for other practitioners may also be reported, but these reports are not required. Professional societies are required to report membership actions taken for reasons related to professional competence. The DEA provides up-to-date information on revocations and voluntary surrenders of its registration numbers. Finally, Medicare and Medicaid exclusions are publicly available through the Federal Register and do not require a specific reporting entity.

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