Healthcare Integrity and Protection Data Bank Merger with National Practitioner Data Bank Completed
Thursday, June 6, 2013
By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health LawThe Health Resources and Services Administration (HRSA) announced that on May 6, 2013, the Healthcare Integrity and Protection Data Bank (HIPDB) officially merged with the National Practitioner Data Bank (NPDB). The two data banks are now known as the NPDB. The HRSA published the final rule to eliminate duplicate data reporting and access requirements. To read the full text of the final rule, click here. To visit the NPDB official website, click here. The merger was authorized for in the Affordable Care Act. Previously, the HIPDB collected information relating to exclusion actions against all healthcare providers such as criminal convictions for health fraud. The NPDB collected data on adverse actions against physicians, dentists and other healthcare practitioners relating to licensure, medical staff privileges and professional liability claims. Now all information is collected on one data base.History of the NPDB and the HIPDB.To understand the changes, you must first know the history of the NPDB and HIPDB. The NPDB was established by Title IV of Public Law 99-660, of the Health Care Quality Improvement Act (HCQIA) of 1986. Its purpose was to improve the quality of healthcare by encouraging state licensing boards, hospitals, other healthcare entities and professional societies to identify and discipline those who engage in unprofessional behavior. The NPDB has been expanded and revised a number of times, but its greatest expansion came on January 28, 2010, when the U.S. Department of Health and Human Services (HHS) issued a final rule implementing Section 1921 of the Social Security Act. This new regulation expanded the information collected and disseminated through the NPDB to include reports on all licensure actions taken against all health care practitioners.Like the NPDB, the HIPDB was created to improve the quality of healthcare. The HIPDB was formed under the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and specifically focused on combating fraud and abuse in health insurance and health care delivery, and promoting quality care. The HIPDB collected reports made by federal and state licensing agencies, federal and state prosecutors, and federal and state government agencies that had excluded a practitioner, provider or supplier from their health plan.Merger Process Took More Than Three Years.The NPDB and the HIPDB were created to provide a resource for state licensing boards, hospitals and other healthcare entities to assist in their investigations of the qualifications of the healthcare practitioners they sought to license or hire. These two data banks served this purpose independently of each other until the passing of the Affordable Care Act on March 23, 2010. Section 6403 of the Act required the Secretary of Health and Human Services (HHS) to maintain a national healthcare fraud and abuse data collection program for reporting certain adverse actions taken against healthcare providers, suppliers and practitioners, and to submit information on the actions to the NPDB. Section 6403 further required the Secretary to establish a process to terminate the HIPDB and ensure that the information formerly collected in the HIPDB is transferred to the NPDB. This merger process was completed on May 6, 2013.
Does This Matter to You?The NPDB has now become one large, all encompassing central data bank for all reports made against all healthcare professionals, whether the report deals with fraud, abuse, licensure actions or malpractice. The HIPDB has been eliminated as an independent data bank. Additionally, all information that was previously held in the HIPDB has been transferred to the NPDB.Users’ access to the NPDB information may expand, meaning that query results may include reports that were previously only accessible through querying the HIPDB. According to the NPDB website, the fees for querying the data bank will remain the same.It is Extremely Important to Defend Yourself in Data Bank Actions.If you receive a notice that a report that has been made to the NPDB, it is extremely important that you hire an attorney to dispute it, submit a rebuttal and appeal it. If your receive notice from the Office of the Inspector General (OIG) that you are being considered for exclusion from the Medicare Program, it is extremely important that you retain an experienced attorney to challenge that decision for you. Such reports and exclusion from Medicare can have devastating effects on your ability to obtain employment. Click here to read a related blog.Contact Experienced Health Law Attorneys. The Health Law Firm routinely represents pharmacists, pharmacies, physicians, nurses and other health providers in investigations, regulatory matters, licensing issues, litigation, inspections and audits involving the Drug Enforcement Administration (DEA), Federal Bureau of Investigation (FBI), Department of Health (DOH) and other law enforcement agencies. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys. To contact The Health Law Firm, please call (407) 331-6620 or (850) 439-1001 and visit our website at www.TheHealthLawFirm.com.Comments?What do you think of the merger between the NPDB and the HIPDB? Do you think it will affect you in any way? Please leave any thoughtful comments below.
About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620. Tag Words: Health Resources and Services Administration (HRSA), Healthcare Integrity and Protection Data Bank (HIPDB), National Practitioner Data Bank (NPDB), Health Care Quality Improvement Act (HCQIA), Department of Health and Human Services (HHS), healthcare provider, healthcare professional, doctor, physician, nurse, dentist, Affordable Care Act, exclusion against physicians, exclusion against healthcare providers, licensure, medical staff privileging, professional liability claims, healthcare fraud, healthcare abuse, Patient Protection and Affordable Care Act (PPACA), defense attorney, defense lawyer, NPDB attorney, NPDB lawyer, The Health Law Firm"The
Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The
Health Law Firm, a Florida professional service corporation, since 1999.
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6/6/2013
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Response to: Healthcare Integrity and Protection Data Bank Merger with National Practitioner Data Bank Completed
Wednesday, June 25, 2014
BarbaTaranoskira A. , D.M.D. says:
Way back in 1991-1993 I was involved in a mal-practice suit. This suit was settled by CNA. The case was not defended. I was never given any information as to what my rights were. Allegations made against me were this patient suffered severe psychiatric damage. Became addicted to drugs and the treatment rendered by me was substandard. This patient had a dry osteomyelitis in several areas of her left and right jaw.
This was verified by anesthetic confirmation. She was in severe pain.
This patient had severe psychiatric problems. She was sexually abused by her natural father. Her grandmother was the supplier of her percocet
pain med. Alcohol abuse was present in several members of her immediate family. My x-rays showed that treatment given was correct.
Her plaintiff's doctors also claimed internal derangement of the TMJ joint and a root canal was 10 mm past the apex. My x-rays showed we were right were the master cone should me. My mal-practice attorney held a bogus depo
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