National Practitioner Data Bank and Illinois Licensees

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The health care provider-patient relationship is fraught with an unequal balance of power. In many ways, when a patient is seeking care for an illness or injury, they are dependent on the health care system and those who work in it. The system creates a vulnerability that, in theory, is offset by how seriously health care providers take their professional responsibilities. Unfortunately, not all health care providers do so, resulting in a need for a reporting system that tracks malpractice complaints and regulatory board actions.

The National Practitioner Data Bank (NPDB) is a web-based repository initially designed to fill this need. The NPDB was created to provide potential employers with current information on a health care provider’s license status and alert them to any potential safety problems. Established by Congress in 1986, the NPDB was to be used as a workforce tool to prevent health care providers and suppliers from moving state to state to avoid the consequences of past poor performance.

As a federal entity, the NPDB works with state licensing boards to ensure the boards are compliant with reporting requirements. For example, the Illinois Department of Financial and Professional Regulation (IDFPR) cooperates with the NPDB to collect and report information on individual state licensees.  IDFPR disciplinary actions and medical malpractice payment reports are provided to the NPDB.

Patients may not query the NPDB for information about their providers. Only registered health care organizations that meet specified federal requirements can query the NPDB for information about a health care practitioner, and then only for specific reasons, such as employment, review, or licensing. Health care providers may also query their own report information, should they want to see what prospective employers or licensing boards will learn about them in the database. All authorized queries result in information shared about medical malpractice payments, adverse licensure action, adverse clinical privilege action, any Medicare/Medicaid exclusions, and judgments or convictions if any  (Self-Query).

In theory, those who have not been subject to any of these actions have nothing to fear. But health care providers often view the NPDB with fear or suspicion. In a recent article, MedPage Today called the NPDB “a boogeyman for physicians, a secretive list where you don’t want your name to appear.”

The NPDB does provide a way for licensees to respond to or dispute a report. Disputing a report triggers a notification to the reporting entity, and providers must then work directly with the reporting entity toward a resolution. If after 60 days the dispute remains unresolved, it goes through a more formal dispute resolution process with the NPDB. Ultimately, however, reports remain on provider’s records “as-is” unless and until the reporting entity requests that it be changed or removed.

In practice, and despite its overall compliant status, Illinois does not make great use of the federal data bank. The state medical licensing board did not query the NPDB at all in 2016. According to Terry Horstman, spokesman for the IDFPR, the department typically gets their information from other sources. While hospital actions or malpractice payments within the state are reported under federal law, Horstman says, background checks are mostly completed using the Federation of State Medical Boards’ Physician Data Center, which functions similar to the NPDB. For these reasons, Horstman claims, the “IDFPR does not find it necessary to utilize the additional fee-based NPDB query.”

Individual employers may take a different approach, but the state’s lack of participation creates an information loophole that may in effect minimize the damage of an adverse NPDB report to Illinois licensees. However, hiring individuals with previous performance concerns may also expose health care facilities in Illinois to litigation and complaints and, in the end, place the most vulnerable people in the system – the patients – in harm’s way.

Jordan Matyas

Jordan Matyas

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Jordan Matyas is a lawyer, lobbyist, and Founder of 1818 Legal, an Illinois professional licensing defense law firm he created in 2014. With more than 18 years of experience practicing law, he represents clients in a wide range of legal matters, including professional license defense, administrative law, land use and zoning, and state, local, and municipal law.

Jordan received his Juris Doctor from the University of Illinois — Chicago School of Law and is a member of the Illinois Bar Association.