Healthcare Organizations Healthcare Integrity and Protection

How to Get Started for Healthcare Organizations

If you represent a healthcare organization such as a hospital, State licensing board, professional society, medical malpractice payer, peer review organization, private accreditation organization, HHS Office of Inspector General, U.S. DEA, Federal or State government agency, or health plan, you may submit queries and/or reports on practitioners, providers, and suppliers using the Data Bank.

What Is the Data Bank?

The National Practitioner Data Bank (NPDB) and the Healthcare Integrity and Protection Integrity Data Bank (HIPDB) are information clearinghouses created by Congress to improve health care quality and reduce health care fraud and abuse in the U.S. Collectively, the NPDB and HIPDB are referred to as the Data Bank.

Together, the NPDB and HIPDB contain reports on health care practitioners, providers, and suppliers, which are submitted by eligible organizations as mandated by Federal law. The NPDB receives and discloses reports on all licensure actions taken against health care practitioners and organizations and all negative actions or findings concluded against healthcare organizations. The HIPDB receives and discloses reports related to final adverse actions taken against health care practitioners, providers, and suppliers.

The Data Bank is used to inform healthcare organizations – such as hospitals, health plans, and health care regulatory entities (e.g., State licensing boards) – that an in-depth review of a practitioner’s past actions may be prudent. Organizations use the Data Bank information along with data from other sources when considering a practitioner for clinical privileges, employment, affiliation, or licensure, or when reviewing a practitioner’s records.

Who Can Access the Data Bank?

The Data Bank contains confidential information that is accessible only to certain groups.

Hospitals, State licensing boards and other healthcare organizations, professional societies, certain Federal agencies and others may query and/or report to the Data Bank if they meet the eligibility requirements set by law. This group must register with the Data Bank before querying or reporting.
Practitioners, providers, or suppliers may access their own information.
Members of the general public may request data that does not identify any particular organization or practitioner.
Plaintiff’s counsel and plaintiff pro se (under certain limited conditions).

Determine Eligibility

As a healthcare organization, you are responsible for determining your eligibility to participate in the NPDB, the HIPDB, or both, and must certify that eligibility to the appropriate Data Bank(s) in writing when registering. Consult the relevant legislation for each Data Bank before you attempt to register.

Note: Practitioners (subjects of reports) do not have to determine their eligibility or register before checking for reports on themselves. See About Searching for Reports and About Responding to a Report for information on how to proceed.

Verify Your Registration

Once you register and have received an email acknowledging your processed Registration form, check for the following:

That your registration form confirms your eligibility to query and/or report to NPDB, HIPDB, or both.
That you have a Data Bank Identification Number (DBID), User ID, and Password.
That the point of contact at your organization (who is responsible for submitting reports to NPDB and/or HIPDB) is correct.

If you need to make any changes to your registration, see Update Profile Information. Some information can be changed online, whereas other information requires that you print, sign, and mail a form to the Data Bank.

Note: HealthCare Organizations are required to renew their registration every 2 years. Thirty days prior to your renewal date, you will receive a notification through Data Bank correspondence. Access is uninterrupted if you renew within that 30-day time period.

Begin Querying and Reporting

Not all healthcare organizations are required to query and/or report.

The NPDB

Table 1. Who Can Query and Report to the NPDB?
Organization	Query	Report
Boards of medical and dental examiners	Optional	Required
State licensing boards for other practitioners	Optional	Required
Hospitals	Required*	Required
Health care entities (also referred to as healthcare organizations) that provide health care services and follow a formal peer review process for the purpose of furthering quality health care	Optional	Required
Professional societies that follow a formal peer review process for the purpose of furthering quality health care	Optional	Required
Medical malpractice payers	Prohibited	Required
Peer Review Organizations	Prohibited	Required
Quality Improvement Organizations	Optional**	No Requirement
Private Accreditation Organizations	Prohibited	Required
State Medicaid Fraud Control Units and Law Enforcement Agencies	Optional**	No Requirement
Agencies administering Federal Health Care Programs and their contractors	Optional**	No Requirement
State Agencies administering State health care programs	Optional**	No Requirement
State Agencies that license health care entities	Optional**	Required
U.S. Comptroller General	Optional**	No Requirement

* Hospitals must query when physicians, dentists, and other health care practitioners apply for medical staff appointment (courtesy or otherwise) or for clinical privileges, and every two years on physicians, dentists, and other health care practitioners who are part of the medical staff or who hold privileges.

** This organization may only receive information reported to the NPDB under Section 1921 of the Social Security Act.

The HIPDB

Table 2. Who Can Query and Report to the HIPDB?
Organization	Query	Report
Federal and State Government agencies	Optional	Required
Health plans	Optional	Required

Definitions

NPDB

Board of medical and dental examiners: A board of medical/dental examiners is a body or subdivision of such body that is designated by a State for licensing, monitoring, and disciplining physicians or dentists. This term includes boards of allopathic or osteopathic examiners or its subdivision, a board of Dentistry or its subdivision, a composite board, or an equivalent body as determined by the State.

State licensing boards: State Licensing Board is a generic term used to refer to State medical, dental and nursing boards, as well as those bodies responsible for licensing other heath care practitioners and entities.

Hospitals: A hospital is defined as an institution primarily engaged in providing, by or under the supervision of physicians, to inpatients: diagnostic and therapeutic services; rehabilitation services for medical diagnosis, treatment, and care; or rehabilitation of injured, disabled, or sick persons. Hospitals must be licensed or approved as meeting the standard established for licensing by the State or applicable local licensing authorities (Section 1861(e) (1) and (7) of the Social Security Act.
Health care entities: A health care entity must provide health care services and follow a formal peer review process to further quality health care. The phrase “provides health care services” means the delivery of health care services through any of a broad array of coverage arrangements or other relationships with practitioners either by employing them directly, or through contractual or other arrangements. This definition specifically excludes indemnity insurers that have no contractual or other arrangement with physicians, dentists, or other health care practitioners.
Peer Review Organizations/Quality Improvement Organizations: Groups of physicians who are paid by the Federal Government to conduct pre-admission, continued stay and service reviews provided to Medicare patients by Medicare approved hospitals. QIOs – utilization and quality control peer review organizations under contract with the Centers for Medicare and Medicaid Services.
Professional societies: A professional society is a membership association of physicians, dentists, or other health care practitioners that follows a formal peer review process for the purpose of furthering quality health care. Examples of professional membership societies may include State, county, and district medical and dental societies and academies of medicine and dentistry.
Medical malpractice payers: A medical malpractice payer is an entity that makes a payment for the benefit of a physician, dentist, or other licensed health care practitioner in settlement of, or in satisfaction in whole or in part of, a claim or judgment against such physician, dentist, or other licensed health care practitioner.

HIPDB

Federal and State Government agencies: Federal and State Government agencies include, but are not limited to, the following:

The U.S. Department of Justice (e.g., the Federal Bureau of Investigation, the U.S. Attorney, the Drug Enforcement Administration)
The U.S. Department of Health and Human Services (e.g., the Food and Drug Administration, the Centers for Medicare and Medicaid Services, the Office of Inspector General)
Any other Federal Agency that administers or provides payments for the delivery of health care service, including (but not limited to) the U.S. Department of Defense and the U.S. Department of Veterans Affairs
Federal and State law enforcement agencies, including but not limited to, State Attorneys General, law enforcement investigators, and district attorneys
State Medicaid Fraud Control Units
Federal and State agencies responsible for the licensing or certification of health care practitioners, providers, and suppliers. Examples of such State agencies include Departments of Professional Regulation, Health, Social Services (including State Survey and Certification and Medicaid Single State agencies), Commerce, and Insurance.

Health plans: The term health plan refers to a plan, program, or organization that provides health care benefits, whether directly or through insurance, reimbursement, or otherwise. Healthcare organizations may be recognized as “health plans” if they meet the basic definition of “providing health benefits.” Health plans include, but are not limited to, the following:

A policy of health insurance
A contract of a service benefit organization
A membership agreement with a health maintenance organization or other prepaid health plan
A plan, program, or agreement established, maintained, or made available by an employer or group of self-insured employers; a practitioner, provider, or supplier group; a third-party administrator; an integrated health care delivery system; an employee welfare association; a public service group or organization; or a professional association
An insurance company, insurance service, or insurance organization that is licensed to engage in the business of selling health care insurance in a State, and that is subject to State law which regulates health insurance

Health plans may include those plans funded by Federal and State governments, including:

Medicare
Medicaid
U.S. Department of Defense
U.S. Department of Veterans Affairs
Bureau of Indian Affairs programs