Text Size

A A A  

Queries

HCQIA requires NPDB reports to be available to hospitals, health care entities with formal peer review, professional societies with formal peer review, state licensing authorities, health care practitioners (self-query only), researchers (non-identifiable data for statistical purposes only), and, in limited circumstances, plaintiff's attorneys. However, this same information must not be disclosed to the general public. NPDB information should be considered together with other relevant data in evaluating a practitioner's credentials. The NPDB does not collect full records of reported incidents or actions and is not designed to be the sole source of information about a practitioner or entity. For example, an NPDB medical malpractice payment report does not necessarily indicate negligence on the part of a practitioner because a medical malpractice payment may be made for reasons other than negligence.

Access to NPDB information is available to entities that meet the eligibility requirements defined in the provisions of HCQIA, Section 1921, and NPDB regulations. Medical malpractice insurers cannot query the NPDB.3 In order to access NPDB data about practitioners, entities that meet the eligibility requirements must first register with the NPDB.

Queriers under HCQIA also receive Section 1921 information. Hospitals, including their human resources departments and nurse recruitment offices, have access to Section 1921 licensure actions to assist with hiring, privileging, and re-credentialing decisions. NPDB information is available to the following queriers under HCQIA and Section 1921:

  • Hospitals (required to query);
  • Other health care entities (optional query);
  • State medical and dental boards (optional query);
  • State licensing boards for other health care practitioners (optional query);
  • Professional societies that follow a formal peer review process (optional query);
  • Health care practitioners (self-query only);
  • Plaintiff's attorneys (under certain circumstances); and
  • Researchers requesting aggregated information that does not identify any particular entity or practitioner (non-identifiable data).

The following queriers have access to information reported to the NPDB under Section 1921 only:

  • Agencies administering Federal health care programs, including private sector entities administering such programs under contract;
  • State agencies administering or supervising the administration of State health care programs;
  • Authorities of a State or its political subdivisions responsible for licensing health care entities;
  • State Medicaid fraud control units;
  • U.S. Attorney General and other law enforcement officials;
  • U.S. Comptroller General; and
  • Utilization and quality control peer review organizations (now known as quality improvement organizations).

Health care practitioners may self-query the NPDB at any time. A plaintiff or an attorney for a plaintiff in a civil action against a hospital may query the NPDB about a specific practitioner in limited circumstances. This is possible only when independently obtained evidence, submitted to HHS, discloses that the hospital did not make a required query on the practitioner. If this is proven, the attorney or plaintiff is provided with information that the hospital would have received if it had queried the practitioner as mandated. This information may be used only against the hospital, not against the practitioner.

Fees

As mandated by law, user fees, not congressionally appropriated funds, are used to pay for all costs of NPDB operations. The query fee in 2012 was $4.75 for each One-Time Query. The Continuous Query fee was $3.25 per practitioner for an enrollment in the service for one year. The Self-Query fee was $8.00. Queries must be paid for by credit card or via automatic electronic funds transfer.