Are You Aware Of Your Status W/the Federally Mandated National Practitioner Data Bank

[NRSKarenRN, BSN, RN]

are you aware of your status with the federally mandated national practitioner data bank?

http://www.njsna.org/regulatorreupdate/nationalpractitionerdatabank(npdb).htm

many nurses are unaware that their name may be on file with the national practitioner data bank (npdb) and/or its companion, the healthcare integrity and protection data bank (hipdb). these two entities were created by federal law; nbdb became operative in 1990 and hipdb in 1999. the intent of the laws creating these data banks was to promote consumer protection by providing health care institutions, health care insurance plans and federal and state agencies with the (some of ) knowledge they need to hire, credential, license or certify individuals who are ethically and professionally competent.

national practitioner data bank:

the npdb must, by law, be consulted by any health care institution seeking to hire a new professional provider and by certifying bodies, insurance companies and federal and state licensing agencies when they are going to certify, credential or license a professional provider, including a nurse, for the first time. (hospitals must then recheck the data bank every two years for every provider's record). information is also required to be reported to the npdb by these same bodies about all professional providers, including nurses, related specifically to:

- malpractice payments made by or for the nurse, including judgment, arbitration decisions and out-of-court settlements, (but not the amount spent on the defense)

- licensure actions such as revocation, suspension, reprimand, censure or probation[1]

if a lawsuit has been filed against a provider, the filing need not be reported to npdb; the lawsuit is reportable only if money has been paid to the defendant. additionally, health care institutions who have taken some action related to a provider's clinical privileges may report those actions to npdb but are not required to do so. [2]

the information contained in the npdb is accessible only to the health care institutions, health insurance plans, professional societies or accrediting bodies and federal and state licensing agencies. plaintiffs' lawyers have limited access to npdb information. additionally, the data is accessible to an individual professional, who can request a self-report; that is, you can obtain a copy of your own record but no other person or entity can do so, unless they are doing it on behalf of one of the official parties described above. a health care provider's defense attorney cannot obtain data from npdb because the provider can self-access a report.

reports obtained from npdb contain the following information on a nurse:

• the nurse's name, home address, date of birth, professional school attended and graduation dates, place of employment; social security number and state license number
  
• the name, title and phone number of the individual who submitted the report listing the nurse's relationship with that individual
  
• the date of any legal judgment and the amount paid
  
• a description of the judgment, settlement, or licensing action
  

when a report is filed, the nurse must by law, receive a copy of the report. if she believes that the information contained in the report is incorrect, she must appeal to the individual who submitted the report to change the record. if that person refuses to change the report, the nurse has 60 days from the date of the report's processing, to request correction from npdb.

npdb is mandated to keep information on those providers who have either been declared ineligible to participate in medicare and medicaid or have been reinstated to participate. hospitals are not allowed to bill for services by any provider who is listed with npdb as ineligible to participate in medicare/medicaid. current law in the state of new jersey requires that the board of nursing report to npdb any nurse whose license has been suspended for substance abuse. these nurses are then deemed ineligible to participate in medicare/medicaid until the suspension has been revoked and npdb has revised the ineligibility report, a process that may take considerable time. until the npdb has declared that the nurse can again participate in medicare/medicaid no hospital will be able to seek reimbursement for her services from those insurers. this has grave implications in terms of the nurse's ability to get back into the work place, when he or she has been successfully treated for substance abuse and has had a nursing license reinstated.

in contrast, the board of medical examiners in the state of new jersey is not required, by law, to report substance-abusing physicians to npdb as long as the physicians are enrolled in a monitoring program. njsna is seeking legislation this year which will give this same prerogative to the board of nursing for nurses.

healthcare integrity and protection data bank:

this is a national data collection program which supplements the work of npdb. it collects information about:

• health care related civil judgments against health care practitioners, providers andsuppliers
  
• health care related criminal convictions against health care practitioners, providers and suppliers
  
• adverse actions taken by federal or state agencies responsible for licensing and certification of health care practitioners, providers or suppliers
  
• exclusions of health care practitioners, providers and suppliers from participation in federal or state health care programs
  
• any other adjudicated actions or decisions established by regulation[3] [4]
  

as with npdb, health plans, licensing boards, law enforcement agencies and federal and state agencies, can access information from hcipdb about potential providers, suppliers or practitioners.

nurses who want to determine if they have a report on file with either the npdb or hipdb can submit a self-query via the web at www.npdb-hipdb.com the query fee for obtaining a self-report is $10 for each program or $20 total, payable by credit card.([color=#3333cc]on july 1, 2004, the self-query assessment fee for each data bank was reduced from $10.00 to $8.00 for each data bank. karen )the turnaround time to receive the report is short, less than a week, recently.

[1]nso: how to stay our of npdb, www.nso.com/newlsetter/features/malpractce.php, 12/23/2003

[2] hrsa: fact sheet on npdb, www.npdb-hipdb.com, 10/11/01, accessed, 12/23/04

[3] ana: data bank to combat fraud effective oct. 1, www.nusingworld.org/tan/99sptoct/fraud.htm, accessed 12/23/04

[4] hrsa: helpful hints for submitting a self-query, www.npdb-hipdb.com/hints.html, accessed 12/23/2003

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[color=#3333cc][color=#006699]about the oig exclusion program

for many years the congress of the united states has worked diligently to protect the health and welfare of the nation's elderly and poor by implementing legislation to prevent certain individuals and businesses from participating in federally-funded health care programs. the oig, under this congressional mandate, established a program to exclude individuals and entities affected by these various legal authorities, contained in sections

1128 and 1156 of the social security act, and maintains a list of all currently excluded parties called the list of excluded individuals/entities.

bases for exclusion include convictions for program-related fraud and patient abuse, licensing board actions and default on health education assistance loans.

healthcare facilites may not hire individuals on the oig sanction list. home health agencies cannot accept homecare referrals or physicians orders from anyone on this list.

free search:

http://exclusions.oig.hhs.gov/search.html

[NRSKarenRN, BSN, RN]

CORZINE, LAUTENBERG CALL FOR IMMEDIATE ACTION ON NURSE DATABANK

Senators discover 17 year lag in critical program

Friday, January 16, 2004

http://www.politicsnj.com/corzine011604.htm

Washington , D.C. - United States Senators Jon S. Corzine and Frank Lautenberg today called on the Health Resources and Services Administration (HRSA) to incorporate information on the disciplinary

actions taken against nurses and other health care practitioners into the National Practitioner Data Bank (NPDB).

In 1987, Congress expanded the NPDB to include the reporting of licensing and disciplinary actions taken against non-physician health care practitioners, including nurses. Specifically, the Medicare and Medicaid Patient and Program Protection Act of 1987 directed the states to develop systems of reporting licensure and disciplinary actions taken against nurses and other licensed health care practitioners. The law was amended in 1990 to include state reporting of adverse actions taken by peer review and accrediting organizations against nurses and other practitioners. The Health Resources and Services Administration, however, has failed to implement these provisions.

"It is unacceptable that, almost seventeen years later, HRSA has yet to implement these laws," the senators stated. They added, "While no one can definitively say that these expansions of the NPDB would have caught Mr. Cullen, the availability of this additional information might well have prevented hospitals from employing Mr. Cullen."

The senators responded last month to allegations against Charles Cullen, a registered nurse in New Jersey who recently confessed to killing as many as forty patients under his care during a sixteen year career, by calling for the development of a national tracking system for nurses. Corzine and Lautenberg have called for the expansion of the NPDB to include all disciplinary and licensing actions taken against nurses and other health care practitioners involved in direct patient care. Current law does mandate that state nurse licensing boards report disciplinary and licensing actions to the databank, however, HRSA has yet to implement this requirement. Until the Congress can pass legislation to further expand the databank, the senators urged HRSA to take action to ensure that current reporting mandates are fully implemented.

"Nurses and other licensed practitioners are playing an increasingly important role in the provision of health care," wrote the senators. "Mr. Cullen's ability to perpetrate such despicable acts against patients highlights serious flaws in our nation's system for screening health care professionals."

Charles Cullen, worked at ten different health care facilities in New Jersey and Pennsylvania. Mr. Cullen was investigated by three hospitals, a nursing home and two prosecutors for causing the deaths of patients, and was fired by five hospitals and one nursing home for suspected wrongdoing. Each time Mr. Cullen was fired, he soon was able find employment at another health care facility. Hospital officials continued to hire him because they had no information regarding his job history. Those who served as references for him generally just confirmed his employment record, without providing information on suspensions, dismissals, or other actions taken against him.

[NRSKarenRN, BSN, RN]

[color=#990000]proposed safe healthcare reporting act would create national nurse database

by e'louise ondash, rn, contributer

friday * august 6 * 2004

nurse zone

had legislation like the proposed safe healthcare reporting act been in place during the 1990s, registered nurse and self-professed serial killer charles cullen may not have been able to allegedly murder more than three dozen of the patients he cared for. cullen is accused of killing patients in nine hospitals and one nursing home in new jersey and pennsylvania.

"the first rule of the medical profession is 'do no harm,'" democratic sen. frank r. lautenberg of new jersey said at a recent press conference in trenton, new jersey. "unfortunately, charles cullen spent his career doing harm to people . . . [he] was a bad apple of the worst kind, but the system allowed him to move from hospital to hospital undetected. charles cullen murdered patients at a number of hospitals in two states, but no one was able to put the pieces of the puzzle together for more than a decade."

lautenberg and democratic sen. jon s. corzine of new jersey recently proposed the safe healthcare reporting act in response to the alleged killings. if passed, hospitals and other health care facilities would be required to report to state professional licensing boards and the national practitioner databank when any adverse action is taken against a health care professional. the facilities also must report violations of federal or state laws governing professional standards-infractions such as suspected drug diversion, falsification of documents or repeated medication errors.

the proposed legislation also requires health care facilities to obtain information from the federal data bank on prospective employees before hiring them. failure to do so could result in penalties of up to $50,000 per violation and health care facilities must comply in order to participate in the medicare program.

full story:

http://www.nursezone.com/job/medicalnewsalerts.asp?articleid=12350

[NRSKarenRN, BSN, RN]

From Forensic Nurse:

Are Databases the Answer?

Nurses Who Kill:

Picking Up the Pieces After the Charles Cullen Arrest

http://www.forensicnursemag.com/articles/431feat1.html

[NRSKarenRN, BSN, RN]

safe health care reporting act of 2004

s.2341 : a bill to amend the health care quality improvement act of 1986 to expand the national practitioner data bank.

sponsor: sen corzine, jon [nj] (introduced 4/22/2004) cosponsors (2)

committees: senate health, education, labor, and pensions

latest major action: 4/22/2004 referred to senate committee. status: read twice and referred to the committee on health, education, labor, and pensions.