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Overview Submitting Reports to the NPDB Reporting Medical Malpractice Payments Reporting Adverse Clinical Privileges Actions Reporting Adverse Professional Society Membership Actions Reporting State Licensure and Certification Actions Reporting Federal Licensure and Certification Actions Reporting Peer Review Organization Negative Actions or Findings Reporting Private Accreditation Organizations Negative Actions or Findings Reporting Exclusions from Participation in Federal and State Health Care Programs Reporting Federal or State Health Care-Related Criminal Convictions Reporting Health Care-Related Civil Judgments Reporting Other Adjudicated Actions or Decisions

Background

Congress enacted legislation leading to the creation of the NPDB because it perceived that the increasing occurrence of medical malpractice litigation and the need to improve the quality of medical care had become nationwide problems that warranted greater efforts than could be undertaken by any individual State. Congress also identified the need to restrict the ability of incompetent physicians and dentists to move from State to State without disclosure or discovery of the physician's previous damaging or incompetent performance. Congress felt that the threat of private money damages liability under Federal laws, including treble damages liability under Federal antitrust law, unreasonably discouraged physicians and dentists from participating in effective professional peer review. Therefore, Congress sought to provide incentives and protection for physicians and dentists engaging in effective professional peer review.

Title IV led to the establishment of the NPDB, an information clearinghouse, to collect and release certain information related to the professional competence and conduct of physicians, dentists, and, in some cases, other health care practitioners. The creation of the NPDB represented an important step by the U.S. Government to enhance professional review efforts by making available to eligible entities and individuals certain information concerning medical malpractice payments and adverse actions.

Subsequent laws expanded the information collected and disclosed by the NPDB and modified its operations.

  • In 1987, Congress passed Section 1921, authorizing the Federal Government to collect information concerning sanctions taken by State licensing authorities against health care practitioners (not just physicians and dentists) and health care entities.
  • Congress later amended Section 1921 with the Omnibus Budget Reconciliation Act of 1990, Public Law 101-508, to add the reporting of "any negative action or finding" by State licensing authorities, peer review organizations, or private accreditation entities. Final regulations for Section 1921 were published in the Federal Register on January 28, 2010, and Section 1921 was officially implemented in the NPDB system on March 1, 2010.
  • Congress also passed Section 1128E, which required the HHS Secretary, acting through the HHS Office of Inspector General (OIG) and the U.S. Attorney General, to create a national health care fraud and abuse control program. A major component of the program was the establishment of the HIPDB. Final regulations for Section 1128E were published in the Federal Register on October 26, 1999. The HIPDB began collecting reports in November 1999 and became fully operational in March 2000. (The HIPDB was a national data bank that received and disclosed certain final adverse actions taken by Federal and State agencies and health plans against health care practitioners, providers, and suppliers. Final adverse actions included licensure and certification actions, health care-related criminal convictions and civil judgments, exclusions from Federal or State health care programs, and other adjudicated actions or decisions.)
  • To eliminate duplication between the NPDB and the HIPDB, Congress passed Section 6403 of the Patient Protection and Affordable Care Act of 2010, Public Law 111-148. The section below describes this law and its impact in greater detail.

Eliminating Duplication Between the NPDB and the HIPDB

On May 6, 2013, NPDB operations were consolidated with those of the former HIPDB. As a result of this consolidation, information previously collected and disclosed by the HIPDB is now collected and disclosed by the NPDB.

While the NPDB and the HIPDB were established for different purposes, overlap existed in some reporting and querying requirements. To eliminate this duplication, Congress passed Section 6403 of the Patient Protection and Affordable Care Act of 2010. This legislation, which amended both Section 1128E and Section 1921, established the NPDB as the single Data Bank to receive and disclose information collected under Title IV, Section 1921 and Section 1128E. The primary impact of this merger was to eliminate duplication and streamline internal operations. The merger did not significantly alter NPDB and HIPDB reporting requirements or access to information. As part of these legislative changes, the Secretary of HHS was required to set up a transition period to transfer all data in the HIPDB to the NPDB, and, once completed, to cease HIPDB operations. Final regulations implementing Section 6403 were published in the Federal Register on April 5, 2013.

Laws Governing NPDB Operations

The three significant laws that currently govern NPDB operations are summarized below. NPDB regulations implementing these laws are codified at 45 CFR Part 60.

Title IV of Public Law 99-660, Health Care Quality Improvement Act of 1986

The intent of Title IV is to improve the quality of health care by encouraging State licensing boards, professional societies, hospitals, and other health care entities to restrict the ability of incompetent physicians, dentists, and other health care practitioners to move from State to State without disclosure or discovery of previous medical malpractice payment and adverse action history. These adverse actions include certain licensure, clinical privileges, and professional society membership actions, as well as Drug Enforcement Administration (DEA) controlled-substance registration actions and exclusions from participation in Medicare, Medicaid, and other Federal health care programs.

Section 1921 of the Social Security Act

Section 1921 was enacted to provide protection from unfit health care practitioners to beneficiaries participating in Medicare and State health care programs and to improve the anti-fraud provisions of these programs. Information collected and disclosed by the NPDB under Section 1921 includes State licensure and certification actions against health care practitioners, entities, providers, and suppliers; negative actions or findings by peer review organizations and private accreditation organizations; and certain final adverse actions taken by certain State agencies, including State law enforcement agencies, State Medicaid fraud control units, and State agencies administering or supervising the administration of State health care programs. These final adverse actions include exclusions from a State health care program, health care-related criminal convictions and civil judgments in State court, and other adjudicated actions or decisions specified in regulations.

Section 1128E of the Social Security Act

The original purpose of Section 1128E was to establish a national data collection program, formerly known as the HIPDB, to combat health care fraud and abuse. Section 1128E information is now collected and disclosed by the NPDB and includes certain final adverse actions taken by Federal agencies and health plans against health care practitioners, providers, and suppliers. These actions consist of Federal licensure and certification actions, exclusions from participation in a Federal health care program, health care-related criminal convictions and civil judgments, and other adjudicated actions or decisions specified in regulations.

Table A-1 outlines these statutes.

Title IV Section 1921 Section 1128E
Established the NPDB as a clearinghouse of information on medical malpractice payments and adverse actions related to licensure, clinical privileges, and professional society memberships of physicians, dentists, and, in some cases, other health care practitioners. Information also includes DEA registration actions and Medicare/Medicaid exclusions. Adds certain adverse actions taken by State licensing and certification authorities, State law enforcement agencies, Medicaid fraud control units, State agencies administering State health care programs, peer review organizations, and private accreditation organizations.

Subjects of reports can include health care practitioners, entities, providers, and suppliers
Adds certain final adverse actions taken by Federal agencies and health plans against health care practitioners, providers, and suppliers.

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