Health Law Matters

PHYSICIAN DATA BANKS - WHICH ONES ARE YOU IN?

By &Steven K. Sanborn,   Mitchell Warner, P.A.

INTRODUCTION

Today, nearly every physician in the United States is in a data bank, some of which provide public access. Of course, the National Practitioner Data Bank (NPDB) has garnered the most attention over the past ten years. Now, a new national data bank is being implemented: The Healthcare Integrity and Protection Data Bank (HIPDB). However, physicians may not realize that there are other national organizations that collect and disseminate information regarding discipline or other bad acts, including the Federation of State Medical Boards (FSMB) and the American Medical Association (AMA). In North Carolina and in other states, medical boards are providing general practitioner information over the intemet. While the dispersement of information can be useful to the public and even beneficial to physicians, incorrect or inaccurate information can be detrimental to a physician's practice.

HIPDB

In 1996, Congress authorized the creation of HIPDB under the Health Insurance Portability and Accountability Act. HIPDB is intended to be a centrally located repository of health care providers, suppliers and practitioners against whom a final adverse action has been taken in regard to the delivery of a health care item or service. These adverse actions include: criminal convictions, civil monetary penalties, license suspension, Medicare/Medicaid/Tricare exclusion, and "any other adjudicated actions or decisions that the HHS Secretary shall establish by regulation."

Although not scheduled to open until October of this year, HIPDB will include adverse actions dating back to August 21, 1996. Included in HIPDB will be adverse licensure information contained in the NPDB dating back to August 21, 1996. For future licensure actions, licensing agencies will report adverse actions to a central agency, which will disperse the information either to HIPDB or NPDB, or both.

Proposed rules released in October by the Office of the Inspector General are very broad, and include within the ambit of "other adjudicated actions or decisions" such things as suspensions or reductions in pay, reductions in grade, terminations, and other personnel related actions. Arguably, this definition includes clinical privilege actions and even denials due to failure to hold voluntary board certifications.

NPDB

The NPDB, which was created pursuant to the Health Care Quality Improvement Act of 1986, has been operational since September 1, 1990. It contains reports of adverse licensure actions, adverse clinical privileges actions, and medical malpractice payments. Hospitals and medical boards are required to query the NPDB when they receive applications for privileges or licensure.

Physicians are supposed to be notified when a report has been entered against them. When they receive notification, physicians can dispute the report and/or submit a statement in response to the report. Physicians may self-query the NPDB to obtain reports, and this now requires a $10 fee.

Recently, the Health Resources and Services Administration published a proposed rule that would require the reporting of practitioner's whose actions were the basis for a malpractice claim, even if the practitioner was not named as a defendant. The intent of this rule is to close a perceived "loophole" in which a practitioner is dropped from a lawsuit, leaving a hospital or other institution as defendant, in order to avoid a report being made to the NPDB. However, the result of this rule could put the malpractice insurer in the position of judge and jury, assigning blame to physicians who were not parties to the lawsuit. It is uncertain at this time whether the rule will be implemented.

FSMB BOARD ACTION DATA BANK

The FSMB Board Action Data Bank is a central repository for formal actions taken against physicians by state licensing and disciplinary boards, Canadian licensing authorities, the U.S. armed forces, the U.S. Department of Health and Human Services, and other regulatory bodies. This information is available to licensing and disciplinary boards, the military, governmental and private agencies and organizations involved in the employment and/or credentialing of physicians.

To be included in the Data Bank, an action must be a matter of public record or be legally releasable to state medical boards or other entities with recognized authority to review physician credentials. Actions fall into two categories: prejudicial (e.g., revocations, probations, suspensions or consent orders) and non-prejudicial (e.g., reinstatements of licensure, replacement of lost or destroyed licenses or license denials). Once reported to the Federation, an action becomes part of the physicians permanent record. Physicians may query the FSMB Data Bank, but they cannot dispute the entry or submit a response statement.

NCMB & OTHER MEDICAL BOARDS

The NCMB has a public access data bank available over the internet (see the NCMB home page at: http://www.docboard.org/nc/nc_home.htm). Information included in this data bank on all licensed practitioners includes address, license status, license number, birthdate, license date and license expiration date, specialty, and education. Furthermore, if a practitioner has had disciplinary action taken against them, there is an indication that the NCMB should be contacted directly for more information.

Many other state medical boards provide information over the internet regarding their licensed practitioners. The most aggressive and controversial of the state medical boards has been the Massachusetts Board of Registration in Medicine, which publishes disciplinary information via the internet that includes criminal convictions, hospital adverse actions, and adverse board actions.

AMA DATA FILES

The AMA compiles data on all licensed physicians in the United States, including basic biographical information, licensure information, board certifications with effective dates and expiration dates, DEA registration status, licensure, Medicare/ Medicaid and other federal sanctions, and other professional activity. This information is compiled into a Physician Profile, and it is disseminated to licensing boards, hospitals, group practices, managed care organizations, and physician recruiters credentialing organizations and other organizations that require background information on physicians. The AMA licenses its Masterfile to several marketing companies that disperse product and service information to physicians.

The AMA also has a public data base that can be accessed over the internet: AMA Physician Select. This provides general biographical information on most licensed practitioners, including education, residency information, specialty, and address. AMA members' profiles include more details, including maps to the medical practice and a listing of AMA Physician Recognition Awards.

CONSUMER GROUP COMPILATIONS

Various "consumer" and patient advocate groups have compiled data banks on who they consider to be "bad" physicians. For instance, a group called Public Citizen publishes a four volume book called "16,638 Questionable Doctors," which lists doctors who have been disciplined by state medical boards and federal agencies.

CONCLUSION

In the trend toward public disclosure of information, nearly all physicians licensed in the United States are accessible in some data bank. Physicians who are unfortunate enough to have some type of licensure discipline, suspension of hospital privileges, medical malpractice payments, and now criminal convictions are likely to be included in a national data bank. Often, having a negative data bank report may decrease a practitioner's likelihood of being credentialed by hospitals or managed care organizations. We recommend that physicians query all data banks periodically to ensure that the information included is accurate.

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Copyright © 2006 -  Mitchell Warner, P.A.        The Medical Law Alert is a publication of the Mitchell Warner Health Law Group. Its purpose is to provide general information about significant legal developments, and should not be construed as legal advice on specific factual scenarios. For more information on the issues discussed in this publication, please contact Edward E. Hollowell at (800) 662-7403 or ehollowell@nchealthlaw.com