The National Practitioner Data Bank

The National Practitioner Data Bank

National Practitioner Data Bank (NPDB) is a database established by federal law that collects data on medical practitioners’ malpractices such as fraudulent medical payments, actions against the practitioner by the board of medical examiners, federal licensing board, and certification actions. It also collects and provides data on practitioner peer and other civil reviews, practitioner health-related criminal convictions, and existing exclusions on a particular medical practitioner or related entity to engage in federal- and state-sponsored or private healthcare programs (Abarelli, 2021). The primary goal of this database was to help flag and eliminate incompetent physicians who could be moving from state to state without disclosing their previous medical-related practice issues in new states and protect the general public health interests. The NPBD has helped improve the quality of health care across the US as it has reduced cases of health care fraud by flagging abuse and incompetent performance in real time.

The NPDB has a reporting system for issues related to healthcare practitioner malpractices, such as medical fraud payments, medical licensing and credential issues, medical malpractices, and other adverse actions that stain the competency of medical practitioners to practice. The reports include the current qualifications and competencies of licensees, state of clinical privileges, any unprofessional conduct or incompetence of a specific medical practitioner, and other actions that may have been taken against a particular practitioner (Abarelli, 2021). State licensing boards, hospitals, and other registered healthcare stakeholders can monitor practitioners across different states in real time through this reporting system.

Further, although the reports developed in the NPDB are not publicly available, hospitals and other viable stakeholders can request the NPDB to provide the required information on a practitioner. By flagging previous actions against a particular medical practitioner, the NPBD restricts the ability of practitioners’ past and existing reported incompetence from moving from state to state and fraudulently billing government healthcare programs. However, its limitations entail that most malpractice payment reports recorded in the NPDB do not indicate the actual magnitude of a medical practitioner’s healthcare incompetence (Studdert et al., 2016), and the reports are not publicly available. NPDB considers all queries as chargeable activities. All registered and authorized entities who make queries from the database are processed through a service billing system. Queries are charged from entities’ credit, debit cards, or other electronic funds transfer (EFT) accounts that the database accepts.

References

Abarelli, N. (2021). Understanding the National Practitioner Data Bank (NPDB). Verity Stream. Retrieved from https://veritystream.com/resources/details/blog/2021/08/25/understanding-the-national-practitioner-data-bank-(npdb).

Studdert, D. M., Bismark, M. M., Mello, M. M., Singh, H., & Spittal, M. J. (2016). Prevalence and characteristics of physicians prone to malpractice claims. New England journal of medicine, 374(4), 354-362.

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The 1986 Health Care Quality Improvement Act established a database that is intended to improve the quality of healthcare in this country. Two other databases have merged with it and now offer many potential advantages.

National Practitioner Data Bank

Tasks:

Describe the National Practitioner Data Bank (NPDB).
Identify the uses of the NPDB.
Analyze any limitations of the NPDB.
Describe how NPDB relates to billing for services.