march 1, 2004
practice and regulatory update
are you aware of your status with the federally mandated national practitioner data bank?
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 and
- 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 
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. the turnaround time to receive the report is short, less than a week, recently.
nso: how to stay our of npdb, www.nso.com/newlsetter/features/malpractce.php
hrsa: fact sheet on npdb, www.npdb-hipdb.com
, 10/11/01, accessed, 12/23/04
ana: data bank to combat fraud effective oct. 1, www.nusingworld.org/tan/99sptoct/fraud.htm
, accessed 12/23/04
hrsa: helpful hints for submitting a self-query, www.npdb-hipdb.com/hints.html
, accessed 12/23/2003
carolyn torre rn,ma,apn,c.
director of practice, new jersey state nurses association
also check to see if you are in oig's website:
recently a hospital had to give back a week's worth of patient care monies because a nurse was practicing with an expired license and was found on a random medicare audit on this list.
[color=#006699]list of excluded individuals/entities
an oig exclusion has national scope and is important to many institutional health care providers because the congress of the united states established a civil monetary penalty for institutions that knowingly hire excluded parties. accordingly, the oig maintains the list of excluded individuals/entities (leie), a database which provides information to the public, health care providers, patients and others relating to parties excluded from participation in the medicare, medicaid and all federal health care programs. http://exclusions.oig.hhs.gov/