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Information for Attorneys

On this page you will find details about what information legal counsel may access in the NPDB (and how), as well as what makes a criminal conviction or civil judgment reportable to the NPDB.

Confidentiality

The information obtained from the NPDB on the practitioner can be used only with respect to a legal action or claim against the hospital, not against the practitioner. Any further disclosure or use violates the confidentiality provisions of Title IV and subjects the plaintiff's attorney and/or the plaintiff pro se to a civil monetary penalty of up to $22,363 per incident.

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A plaintiff's attorney or a plaintiff representing himself or herself (pro se) is permitted to obtain certain information from the NPDB under the following circumstances:

  • A medical malpractice action or claim must have been filed by the plaintiff against a hospital in a state or federal court or other adjudicative body;
  • The practitioner on whom the information is requested must be named in the action or claim; and,
  • Evidence must be submitted to the Department of Health and Human Services demonstrating that the hospital failed to submit a mandatory query to the NPDB regarding the practitioner named by the plaintiff in the action.

Evidence that the hospital failed to query the NPDB must be obtained by the plaintiff through discovery in the litigation process. This evidence is not available to the plaintiff through the NPDB.

The plaintiff's attorney must submit all of the following to the NPDB:

  • A letter requesting authorization to obtain information;
  • Supporting evidence that the hospital did not make a mandatory query of the NPDB regarding the practitioner named by the plaintiff in the action or claim; and,
  • Identifying information about the practitioner on whom the attorney wishes to query.

Once the request for access is approved, the attorney is entitled to a one-time-only disclosure. The attorney will receive only that information available in the NPDB at the time the hospital was required to query but did not. It also includes information on any reports that subsequently were voided. Information that will be made available to the plaintiff's attorney is limited to reports submitted to the NPDB under the authority of Title IV, including:

  • Medical malpractice payments;
  • State licensure actions taken by a State medical or dental board;
  • Clinical privileges actions;
  • Professional society membership actions;
  • Drug Enforcement Administration controlled-substance registration actions; and,
  • Exclusions from Medicare, Medicaid, and other Federal health care programs.

The "Attorney Access" portion of the NPDB Guidebook's Querying chapter provides further information, examples, and instructions about where to mail the above materials.

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Defense attorneys are not permitted access to the NPDB. However, the defendant practitioner is permitted to perform his or her own Self-Query to obtain any reports matching his or her name that have been submitted to the NPDB. The Self-Query response will show any information about medical malpractice payments, adverse licensure or privileges actions, or judgments and convictions that are found. Self-Queries are $4.00 per order.

 

What is Reportable?

Refer to our Reporting Health Care Related Criminal Convictions and Civil Judgments infographics for a visual guide to what information attorneys must report to the NPDB. Our Judgment or Conviction Reporting information page contains details about your responsibilities for reporting state health care-related prosecutions and civil judgments to the NPDB. You may also expand and collapse summaries of when to report criminal convictions and civil judgments, below.

Federal or State Prosecutors in Criminal Cases

A criminal conviction against a health care practitioner, provider, or supplier is reportable to the NPDB when it is related to the delivery of a health care item or service and includes:

  • A conviction entered against the individual or entity in a Federal, state, or local court, regardless of whether there is an appeal pending or whether the conviction or other record relating to criminal conduct has been expunged.
  • A finding of guilt against the individual or entity in a Federal, state, or local court.
  • A plea of guilty or nolo contendere by the individual or entity accepted by a Federal, state, or local court.
  • A case when the individual or entity has entered into participation in a first offender, deferred adjudication, or other arrangement or program where judgment or conviction has been withheld.
  • Health care-related injunctions also must be reported.

Federal or State Attorneys in Civil Cases

A civil judgment against a health care practitioner, provider, or supplier is reportable to the NPDB regardless of whether the judgment is on appeal, when it is related to the delivery of a health care item or service. For multi-party suits:

  • A government agency in a multi-party suit must report the entire action, including all amounts awarded to all claimants, both public and private.
  • If a government agency is not a party, but there are multiple health plan claimants, the health plan with the largest award must report the total action for all parties.