National Practitioner Data Bank Malpractice Case Reporting (A Can of Worms)

The Health Care Quality Improvement Act of 1986 (HCQIA) says that state medical boards and health care entities must report payments made in malpractice actions on behalf of physicians.  Many errors are made and innocent physicians can be reported incorrectly (See the end of this article)  Here are the NPDB malpractice reporting rules.

The following payments must be reported to the NPDA (National Practitioner Data Bank often mistakenly called the National Practitioner Data Base)

● A malpractice settlement or court judgment that includes a stipulation that the terms are kept confidential.

● A malpractice settlement is structured so that the claimant receives an annual sum for each year he or she is alive.

● A malpractice settlement that involves multiple practitioners that are named in the claim and named in the release.

● A malpractice payment made for the benefit of a licensed resident or intern.

● A practitioner's fee refunded by an entity (including a solo incorporated practitioner) as the result of a written demand.

● A practitioner defendant released from a medical malpractice lawsuit as a condition of settlement.

● A medical malpractice payment made for the benefit of a practitioner who settled out of court

Don't Confuse State Rules with NPDB Rules (NPDB Reporting has No Dollar Limit)

Warning: Some states such as California require that any medical malpractice judgment or arbitration award of any amount or settlement be reported but only if it is over a certain dollar limit. The dollar limit in California is $30,000. BUT this rule applies to the Board and does not set a limit for NPDB reporting.

Some payments are mistakenly reported and should be corrected. For example a waiver of a debt is not considered a payment and should not be reported to the NPDB. So if a patient complains that treatment was not effect or unnecessary you can write off the bill and not be reported.

A very interesting issue is the statement by the NPDB that the payment has to be made with respect to a written complaint or claim.

Here is what the NPDB says:

“Written Complaint or Claim

To be reported to the NPDB, a medical malpractice payment must be the result of a written complaint or a written claim demanding monetary payment for damages. The NPDB interprets this requirement to include any form of writing, including pre-litigation written communications. The NPDB, not any other entity, determines whether a written claim has occurred for purposes of filing a report.”

This raises an interesting point. If a lawyer makes an oral claim and gets paid a lot of money for an injured client is this reportable? Does the written settlement agreement constitute a “written complaint or claim” for NPDB purposes? This is not clear.

Another important issue is a malpractice VERDICT or arbitration decision which gets overturned on appeal.  How can you clear your record with the NPDB?  This does not happen automatically.

Another danger area are malpractice insurance policies that cover multiple doctors. Sometimes a claim against one doctor will mistakenly be reported against all of them. Or in a related “snafu”, multiple doctors can be sued. All are dismissed in a settlement. Among those dismissed are doctors who are entirely without fault. Do they get reported? The answer should be “no” but how do you prove that the payment related only to the doctor at fault and you were innocent? THIS IS A MAJOR and FREQUENT issue we confront.

Daniel Horowitz, a renowned expert in physician licensing, offers top-tier representation for all your NPDB (National Practitioner Data Bank) concerns. With his extensive experience and expertise, you can trust him to handle your case with the utmost professionalism and skill.