NPDB Insights - August 2020

Is It Reportable?

A defendant health care practitioner agreed to settle a medical malpractice claim in exchange for dismissal from a lawsuit. All parties involved in the lawsuit agreed to the condition. Should the resulting payment be reported to the NPDB?

Yes. The payment is the result of the condition that the defendant health care practitioner be dismissed from the lawsuit, the payment can only be construed as a payment for the benefit of the health care practitioner and must be reported to the NPDB.

Attestation Updates: Confidentiality and Agents

Attestation is our national education and outreach effort to ensure that all eligible organizations are meeting their reporting, querying, and confidentiality requirements.

Effective August 2020, there were 3 changes to attestation:

• In addition to attesting to reporting compliance, hospitals should attest that they have queried the NPDB as required by federal law.
• Agents should attest that they have complied with federal law when querying and/or reporting on an entity's behalf.
• All entities with the ability to query should attest to their compliance with confidentiality requirements.
• As part of their registration renewal process, organizations are prompted to complete the attestation process every 2 years. The NPDB sends a 60-day reminder email to an organization's Data Bank administrator prior to the registration renewal due date.

For more information, see our How to Attest and About Authorized Agents pages.

Investigations and the NPDB

The NPDB has an expansive interpretation of the term "investigation" related to clinical privileges/panel membership. An investigation is not limited to a health care entity's gathering of facts; the NPDB considers an investigation starting as soon as the entity begins an inquiry and ending only when the entity's decision-making authorities take a final action or make a decision not to further pursue the matter. A practitioner’s awareness that an investigation is being conducted is not a requirement for filing a report with the NPDB.

An Investigation

Not An Investigation

A formal, targeted process used by a health care entity when issues related to a specific practitioner's professional competence or conduct are identified. The investigation must be focused specifically on the practitioner in question. The investigation must concern the professional competence and/or professional conduct of the practitioner in question. To be considered an investigation for purposes of determining whether an activity is reportable, the activity generally should be the precursor to a professional review action. An investigation is considered ongoing until the health care entity's decision-making authority takes a final action or formally closes the investigation.

A routine, formal peer review process under which a health care entity evaluates, against clearly defined measures, the privilege-specific competence of all its practitioners.

In some cases, the NPDB may take into account a health care entity's bylaws or other governing documents to determine whether an investigation has started or is ongoing. However, the NPDB remains the ultimate authority on determining whether an investigation exists.

Investigations should not be reported to the NPDB. However, a surrender of clinical privileges (including any restriction of privileges) or failure to renew clinical privileges while under investigation or to avoid investigation must be reported.

For more information on investigations and how they relate to the NPDB, visit the Clinical Privileges Investigations section of the NPDB Guidebook or contact our Customer Service Center.

Dear NPDB

When should my hospital or other health care entity query?

The laws governing the NPDB require all hospitals to request information from the NPDB as follows:

• When a physician, dentist, or other health care practitioner applies for medical staff appointment or for clinical privileges at the hospital
• Every 2 years for all physicians, dentists, and other health care practitioners who are on the hospital's medical staff or who hold clinical privileges at the hospital
• Each time a practitioner wishes to add to or expand existing privileges
• When a practitioner applies for temporary privileges
• Hospitals are also required to query on courtesy staff who are considered part of the medical staff (even if they are afforded only nonclinical professional courtesies), and each time a locum tenens practitioner submits an application for temporary privileges.

Other health care entities that are eligible to query may choose to query for the following reasons:

• Privileging decisions
• Employment decisions
• Professional review activities
• Licensing or certification decisions
• Fraud and abuse investigations
• Certification to participate in government programs
• Information gained from a query is intended to be used in combination with information from other sources and should not be used as the sole source of verification of professional credentials.

For more information about the querying process, check out our Querying the NPDB page. If you have specific questions about querying, visit our Querying Help and FAQs page.