National Practitioner Data Bank Changes That May Affect You

July 2015Articles Allegheny County Medical Society Bulletin

Although it may be debatable whether privacy is dead or still on life support, physicians have had to live with a system that allows hospitals, insurers, medical boards and others to discover some of their darkest secrets for a quarter century. Physicians who have been disciplined, lost hospital privileges, been convicted of fraud or settled malpractice cases have learned to accept the fact that these incidents will follow them for the rest of their careers. Some of the more ambiguous rules under which this system operates have now been clarified by the federal agency that administers the program, and some perceived loopholes have been narrowed. As a result, some events that previously were not reportable may now be required to be reported.

Some background: Since 1990, reports of certain adverse credentialing and licensure actions and malpractice payments on behalf of physicians have been collected by the National Practitioner Data Bank (NPDB), which was created under the Health Care Quality Improvement Act of 1986. The Health Insurance Portability and Accountability Act of 1996 (HIPAA), better known for its health privacy provisions, created the Healthcare Integrity and ProtectionData Bank (HIPDB) to combat health care fraud and abuse and capture convictions and exclusion actions. In 2013, the HIPDB was merged into the NPDB.

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