Risk Management

Reporting Requirements of the National Practitioner Data Bank

Digest, Winter, 1991

If a case is settled or an adverse verdict rendered against an individual physician, Title IV of Public Law 99-660 mandates that the payment be reported by the malpractice insurance carrier to the National Practitioner Data Bank. Reports of all such payments made by OMIC on behalf of an insured are first discussed with the insured-ophthalmologist before being filed with NPDB. Payments made as a result of a claim or lawsuit against an entity such as a professional association do not need to be reported.

In addition to indemnity payments, the Data Bank requires reporting of:

• Certain adverse privilege actions taken by a health care entity.
• Licensure actions taken by a particular state board responsible for the licensing, monitoring and discipline of physicians or dentists.

The Data Bank represents a depository of information relating to the “professional competence and conduct” of physicians, dentists and other health care practitioners. This information is made available to state licensing boards, hospitals and other health care entities, and professional societies to provide data to those involved in credentialing or regulating physicians.

Another group allowed to request information from the Data Bank are medical malpractice attorneys and plaintiffs involved in a proceeding against a hospital and requesting information about a specific practitioner who is also named in the action or claim. Their access to the Data Bank is restricted, however, and they must first demonstrate that the hospital failed to request the information from the Data Bank as required. Any information they receive from the Data Bank may only be used in litigation resulting from the action or claim against the hospital.

The Data Bank’s reporting and querying components are summarized in the accompanying table. (See page H-35 for changes to the Data Bank’s reporting requirements since this article was first published.)