Posted by Bill Sandweg on 07 November 2016.
In the late 1980’s Congress passed a series of laws which created the National Practitioner Data Bank (“NPDB”). In an effort to promote better health care and reduce fraud, the statutes and the rules related to them require reporting of a number of important actions dealing with health care such as medical malpractice payments, actions by a state accrediting board which are adverse to a practitioner, actions which reduce hospital privileges of a practitioner, Federal licensure and enforcement actions, negative actions or findings by peer review organizations, exclusions from participation in the Medicare or Medicaid systems, and health care related civil judgments and criminal convictions in Federal and state courts. All of these actions have one thing in common, they raise red flags about the competence or ability or trustworthiness of a doctor or other medical practitioner.
Hospitals, insurance companies, state licensing boards, healthcare groups and others are able to inquire of the NPDB about a particular doctor or other professional to see whether she or he should be admitted to practice, allowed to practice in the hospital, sold insurance at good rates or be offered employment.
These inquiries theoretically permit those making decisions about doctors and other practitioners to identify problem doctors and to make informed decisions about whether and under what circumstances they should be licensed or allowed to practice in the hospital. It is important to note, however, that just because a doctor has paid on a malpractice claim, that does not mean that he or she is a bad doctor. Mistakes happen even to the best of us. Multiple malpractice payments, on the other hand, do suggest a significant problem. The data bank reports also identify those who have been found to have defrauded Medicare or Medicaid so they can be prevented from doing it again. This last one doesn’t always work as well as we would hope since there are repeat offenders who just set up shop under a different name and go back to their old schemes.
The public may not inquire about a particular doctor but may access data as a whole about such subjects as how many malpractice payments were made in a given year, in what amounts, for what kind of injuries, in what states, and for what allegations of malpractice. Next week I will write a post with an analysis of the reported payments made for medical malpractice in 2015.