NPDB Appeals

Appeal of National Practitioner Data Bank Reports

The National Practitioner Data Bank (NPDB) is a repository of reports made against physicians and other healthcare professionals of medical malpractice awards/settlements, licensure restrictions, hospital/medical staff privilege issues and corrective actions or other misconduct. Information in the NPDB is not available to the general public. Only state licensing boards, insurance payors, and hospitals can search the reports.

 

A report to the NPDB can have serious and long-lasting consequences for a physician. Reports can be queried by state licensing bodies, hospitals and other healthcare facilities to assist in investigating the qualifications of a physician or other healthcare professional. An adverse report can result in the denial of medical staff privileges, licensure suspension or revocation, exclusion from the Medicare Program, an increase to professional liability insurance premiums, and can ruin a physician’s professional reputation and career advancement.

 

If a NPDB report has inaccurate information or the subject matter of the report was not a “reportable event” under the law,  a physician can dispute the report to protect him/herself. The physician subject of the NPDB Report can add a “Subject Statement” to the Report to give perspective on the reported event, explain his/her conduct, or provide additional information that can mitigate the negative impact of the Report. The first step in the dispute process is to send a request to the reporting organization to correct factual inaccuracies in the Report, or void the Report in its entirety because the matter was not a “reportable event.”

 

If after 60 days of filing the dispute, the physician has received no response from the reporting organization, or the reporting organization’s response is unsatisfactory, the physician can elevate the Report to dispute resolution status, and a NPDB Dispute Resolution Manager will make a final determination as to whether the Report should be corrected or voided. If adequate relief is not obtained by the physician, the dispute can be elevated for reconsideration by the Department of Health and Human Services (“DHHS”). The authority to reconsider the dispute outcome has been delegated to the Division of Practitioner Data Banks within the Health Resources and Services Administration’s (“HRSA”) Bureau of Health Workforce.

 

The NPDB dispute resolution process is a highly technical procedure governed by specific regulatory provisions. It is crucial to retain an experienced NPDB appeals attorney familiar with the Code of Federal Regulations applicable to the NPDB and which events are reportable to the NPDB. Concierge Healthcare Attorneys, LLC has successfully disputed NPDB Reports and negotiated resolutions with reporting entities.

 

Physicians may challenge dispute resolution decisions in federal court under the Administrative Procedure Act. To succeed in such a case the physician must demonstrate that the administrative agency action was arbitrary, capricious, an abuse of discretion, or otherwise not in accordance with law.

 

If you receive a notice that a Report has been made to the NPDB, it is extremely important that you consult with an experienced NPDB appeal lawyer in a timely fashion. Concierge Healthcare Attorneys has decades of experience working within the medical community and can effectively handle your NPDB report appeal.

 

Contact Concierge Healthcare Attorneys

 

Concierge Healthcare Attorneys, LLC takes a dedicated approach to client care. We know how critical a timely appeal of NPDB Reports is to medical professionals, and we make your needs our priority. Contact us online or by phone at (312) 804-1739 to discuss your NPDB appeal.