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National Practitioner Data Bank
Hospitals are required to report certain adverse clinical privileging actions and medical malpractice payments to the National Practitioner Data Bank (NPDB). Since the NPDB was established by the Health Care Quality Improvement Act (HCQIA) in 1986, compliance with these reporting obligations has been largely entrusted to hospitals with little enforcement action by the United States Department of Health and Human Services. There are now reports that the federal government has begun auditing compliance by hospitals with the NPDB reporting requirements.
The HCQIA provides sanctions that can be imposed for failure to make required reports, including civil monetary penalties and loss of immunity for professional review activities. It remains uncertain whether HHS will seek sanctions as part of its enforcement push. Hospitals should be prepared for such potential audits. A review of the procedures and policies for reporting privileging actions and medical malpractice payments would be prudent.
If you have any questions, please contact Richard C. Kraus or Gary J. McRay by using the form below.
Categories: Audits, Compliance, Hospitals, Physicians
Richard Kraus has 30 years of experience in the area of health care law. His representation of individual health care professionals as well as hospitals, health systems, long term care facilities and multi-practitioner clinics, provides an understanding of clinical and business realities in health care as well as legal and regulatory requirements.
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Gary has nearly 40 years of experience and has earned a reputation for handling sophisticated transactions for hospitals, managed care organizations, HMOs, health insurers, physician groups and other provider entities and for helping his clients stay on top of complex regulatory issues, such as Anti-Kickback Statute, Stark II, Medicare, Medicaid, and BCBSM reimbursement appeals.
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