The National Practitioner Data Bank (“NPDB”) was created by Congress and contains information related to “certain adverse actions related to health care practitioners, entities, providers, and suppliers.”[1] The law determines what types of adverse actions are reportable to the NPDB, however, most reporting entities error on the side of over-reporting making disputing an erroneous report much more important.
The NPDB is used nationwide by those within the healthcare industry to investigate the backgrounds of practitioners before making an offer of employment. Moreover, a practitioner with a “rap sheet” is far less likely to be accepted by a health insurance company as a treater based on the NPDB report alone. With that in mind, figuring out how to not only request your adverse action report from NPDB, but then how to properly dispute said report is of the most importance. Below is a “how to” guide for doing just that.
Requesting a Report from NPDB
To request a report from NPDB follow the instructions below:[2]
- Go to the NPDB website at www.npdb.hrsa.gov;
- Click the “self-query” link on the right-side of the homepage;
- Click the “Place a Self-Query Order” link in the middle of the page;
- A box will appear, click the “Rules of Behavior” link and read the terms;
- In the same box, click the “Subscriber Agreement” link and read the terms:
- After reviewing the terms, check the “I accept” box and click the “Submit and Continue” link on the bottom right-side of the box; and
- Provide the requisite personal information and submit your order request.
If the NPDB report evidences any adverse action, you will need to dispute the report[3] immediately. Directions for doing so are provided below.
Disputing a Report with the NPDB
As the subject of an Adverse Action Report with the NPDB, you are entitled to dispute the report. To do so, you are the only one who can provide a statement to augment/dispute the report. A statement may not be made on your behalf by an attorney; rather, your attorney can only provide you with a proposed statement you can submit to the NPDB. Once your statement is submitted, it will be added to the report, and is disclosed to anyone who receives a report, or who has received a report in the past three (3) years.
To place your report in dispute status, you must follow these steps:
- On the NPDB homepage, click Sign In. Then click Sign In with a Report Number. The Sign In with a Report Number page displays.
- On the Sign In with a Report Number page, enter the Report Number and Password provided in your notification of the report, then click Sign In.
- Read through the information on the Rules of Behavior page, check the box to acknowledge the rules, and then click Continue.
- On the Practitioner Identification page, enter your Date of Birth and/or your SSN/ITIN. Click Continue.
- On the Report Response Options page, select Add a statement or dispute to this report. The Subject Statement and Dispute page opens.
- On the Subject Statement and Dispute Page, you can add a statement of up to 4,000 characters in the Subject Statement section. You can also place the report in dispute by checking the box in the Dispute section.
- Check to see that your address information is current and update it if necessary. An email address is required. Enter your Certification Data and click Submit to Data Bank.
- On the Subject Statement and Dispute Status page, select View Report to view a PDF version of the Report you can save for your records. No other copy of the report will be sent to you. The updated Report containing your new Subject Statement and/or Dispute information will be sent to the reporting entity identified in Section A of the report and all entities who have previously received the report.
Note: Once a report is in dispute, contact the health care organization that entered the report to resolve the issue. - Click Return to Report Response Options to view your Activity History or reply to a NPDB message.
Once a report is placed in dispute, the reporting health care organization can correct the report, void the report, or leave the report unchanged. If after 60 days you have received no response from the reporting health care organization or you are unsatisfied with the response you received, you can elevate the case to Dispute Resolution.
Elevate Dispute Resolution
To elevate your report to Dispute Resolution, follow these steps:
- On the NPDB homepage, click Sign In. Then click Sign In with a Report Number. The Sign In with a Report Number page displays.
- On the Sign In with a Report Number page, enter the Report Number and Password provided in your notification of the report, then click Sign In.
- Read through the information on the Rules of Behavior page, check the box to acknowledge the rules, and then click Continue.
- On the Practitioner Identification page, enter your Date of Birth and/or your SSN/ITIN. Click Continue.
- On the Report Response Options page, select Request a Dispute Resolution. This link only appears on this page after you have placed the report in dispute for 60 days.
- On the Request for Dispute Resolution page, you must select the reason for requesting the review and provide proof that resolution with the reporting entity was attempted.
- Enter your Point(s) of Dispute, attaching any supporting documentation.
- Check that your addresses are entered correctly, enter the Certification Data, and click Continue. An email address is required. The Request for Dispute Resolution Status page appears.
- On the Request for Dispute Resolution Status page, if you are ready to elevate your report to Dispute Resolution, read the instructions carefully and click Continue.
- Print the Request for Dispute Resolution document. If you did not electronically attach all documentation during steps 6 and 7 above, mail a signed and dated copy of the Request for Dispute Resolution document to the specified address with the following information:
- Documentation substantiating that the reporting health care organization’s information is inaccurate must be submitted. The documentation must directly relate to the facts in dispute and contribute substantially to a determination of the accuracy, completeness, timeliness, and relevance of the report. The documentation must be 20 pages or less, including all attachments and exhibits; more information is requested if necessary.
- Proof you attempted to resolve the disagreement with the reporting health care organization and that it was unsuccessful must be provided. For example, a copy of whatever correspondence you had with the health care organization, and their response, if any, fulfills this requirement.
- Click Return to Report Response Options to view your Dispute Resolution Progress, view your Activity History, or reply to a NPDB message.
The Secretary reviews your disputed report to determine if the action is reportable, and whether the report accurately describes the reporter’s actions and reasons for action as stated in the reporter’s decision documents. The Secretary does not review the merits of a medical malpractice payment, or the appropriateness of/basis for an adverse action or a judgment or conviction. Issues of due process are not reviewed by the Secretary; you must resolve them with the reporting health care organization.
When the review is complete, the Secretary will decide whether a report is accurate, complete, timely, and relevant and whether the issues in dispute are outside the scope of Dispute Resolution.
[1] See www.npdb.hrsa.gov.
[2] Ibid.
[3] The information contained in this section is compiled from the NPDB website.