Our healthcare and business law firm consistently works with physicians who are dealing with complications resulting from adverse reporting to the National Practitioner Data Bank (“NPDB”). Certain entities, including medical licensure boards, facilities with a peer review process, and medical malpractice payers, have a duty to report specific actions or events to the NPDB. Any practitioner who has had the misfortune of having an action reported to the NPDB is likely aware of the negative impact such a report can have on his or her ability to practice. Sometimes, however, the information reported to the NPDB is inaccurate in whole or in part or, even if accurate, inappropriately reported. Inaccurate or inappropriate reports can have equally serious adverse impacts on a medical provider’s ability to practice as any correctly submitted NPDB report. This post outlines the process for disputing a report that is inaccurate or inappropriately report. If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, email@example.com. You may also learn more about our law firm by visiting www.hamillittle.com.
STEP 1: Dispute the Report with the Reporting Entity
The NPDB directs providers to contact the reporting organization before initiating a formal dispute with the NPDB. Doing this is as simple as it sounds: contact the reporting entity, explain why the report is inaccurate or not reported in accordance with NPDB requirements, and request they correct or void the report. If the report is accurate, yet a new action should have also been reported, you can also request that the reporting entity file a Revision-to-Action Report. Although reporting entities have a duty to correctly report to the NPDB, entities can be sanctioned for not reporting. As such, entities have an incentive to report if there is any question as to whether reporting is required. Motivating an entity to modify a report to make it more factually accurate is a much easier feat than motivating an entity to void a report. In our experience, entities have little incentive to void a report; they would rather the provider dispute the report to HHS and have HHS direct them to void the report.
When you initiate the dispute with the reporting entity, you must also place the report in dispute status, which you can do through the NPDB website under Your Reports à Options à Current Dispute Status à select “Dispute this Report” à and complete the certification and Submit to the NPDB. For more, see “How to Dispute a Report,” available here. We recommend saving a copy of the report in this dispute status for your records. Placing the report in dispute status does not trigger a review by the Department of Health and Human Services (“HHS”).
STEP 2: Elevate the Dispute to HHS
If you or your attorney are unsuccessful in persuading the reporting organization to correct or void the report, the practitioner can initiate a dispute with the NPDB directly, but only after sixty (60) days have lapsed from the day you raised the dispute with the reporting entity. Note, if before the 60-day window closes, you receive notice that the reporting entity refuses to correct or void the report, you may immediately elevate the dispute to HHS without. To initiate a dispute with HHS, you must submit a request to the Secretary of HHS. The Secretary delegates the Division of Practitioner Data Bank of the Health Resources and Services Administration (which is responsible for oversight of the NPDB) to complete the review.
HHS’s jurisdiction to review reports is strictly limited, such that it can only review: (a) “if the report was submitted in accordance with reporting requirements”; (b) “if the reporting organization is eligible to report the information”; and (c) “if the report accurately depicts the action taken by the reporting organization and basis for the action in the organization’s written record.” Any other disputes must be resolved between you and the reporting entity directly. Because HHS’s jurisdiction to review reports is strictly limited, it is important to frame your request in a way that would allow HHS to exert its authority. The most efficient way to submit the dispute and all supporting documentation is through your online NPDB portal. For more information on these steps, see “How to Elevate a Report to Dispute Resolution,” available here. A forthcoming blog post outlines more about this process with an example decision from HHS requesting the entity void the report.
If you have a question about the NPDB or would like to discuss this blog post, you may contact our healthcare and business law firm at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta), or by email, firstname.lastname@example.org. You may also learn more about our law firm by visiting www.hamillittle.com.
*Disclaimer: Thoughts shared here do not constitute legal advice.