How to Dispute a National Practitioner Data Bank (NPDB) Report

If you are a healthcare practitioner who has been reported to the National Practitioner Data Bank (NPDB), you have the right to dispute that report. The NPDB will consider correcting or voiding a report, but only when the dispute falls within three specific areas it is legally permitted to evaluate:

• Whether the report was submitted in accordance with NPDB reporting requirements, including whether the reporting entity was even eligible to report the information in the first place
• Whether the report accurately depicts the action taken, as reflected in the written record the reporting entity provided
• Whether the record the reporting entity submitted actually supports the basis it gave for the action taken

The NPDB exists because Congress wanted to help hospitals, licensing boards, and other eligible entities make better decisions about who they credential, hire, and privilege. To do that job well, the information in it has to be accurate. That's the lens the NPDB views every dispute through: not whether the underlying decision was fair, but whether the report itself is correct.

I know this scope well because I spent seven years inside the NPDB's policy branch, drafting the agency's own responses to disputes like these. I've seen exactly how the NPDB interprets and applies its regulations during the dispute process.

Step 1: Enter the Report into Dispute Status

The first move is placing the report into Dispute Status. You can do this at any time. It puts a notation on the report indicating you disagree with it, and that notation stays visible to anyone who queries your record while the dispute is active.

Entering Dispute Status does not, by itself, trigger any review. It's the formal starting point, not the review itself.

Step 2: Dispute the Report with the Reporting Entity

Next, you need to attempt to resolve the issue directly with whoever reported you, the hospital, the health system, the licensing board, or whichever entity submitted the report. This step is required before the NPDB will consider elevating your case. Put your position in writing, and keep a copy of everything you send along with any response you get back.

This is also the point where having the right expert involved actually matters most, not later. The argument you make to the reporting entity becomes part of the written record the NPDB will eventually review if the case gets elevated. Depending on who the reporting entity is, having an overall strategy to follow for disputing the report from the very beginning is best, and obtaining the advice of a seasoned expert at this stage is well worth it.

Step 3: Elevate to Dispute Resolution

If you don't get the response you're looking for from the reporting entity, and it has been at least 60 days since you entered Dispute Status, you can request that the report be elevated to Dispute Resolution. If the reporting entity tells you in writing during that 60-day window that it refuses to correct or void the report, you can request elevation immediately, without waiting out the full period.

Step 4: Dispute the Report with the NPDB

This is the stage where the case is actually reviewed by the federal government.

By this point, you should already have an expert and a lawyer involved, ideally from Step 2, not starting now. Our office is happy to triage the issue alongside your attorney from the outset, or to help you find one if you don't already have counsel in this space. NPDB dispute resolution is a narrow, specialized field, and the strategy you build at the very beginning, when you first respond to the reporting entity, can shape the strategy and argument available to you here. Having a strategy from the beginning can make the most of the limited time your case has once it's in front of the NPDB. Whoever is helping you should understand which arguments actually fall within NPDB's jurisdiction, and be involved from day one rather than brought in only once the case has already been elevated.

What the Dispute Resolution Process Will Not Review

It's just as important to understand what's off the table. The Dispute Resolution process does not include reviewing:

• The underlying reasons for the report, such as the merits of a medical malpractice claim, or the appropriateness of or basis for other types of reports
• Whether the reporting entity followed proper due process during its own internal proceedings; due process issues have to be resolved between you and the reporting entity directly, outside the NPDB dispute framework

The Mistake Most Practitioners and Their Lawyers Make

The most common mistake I saw practitioners or their lawyers make when disputing a report to the NPDB is bringing the same argument they made to their Medical Executive Committee or their employer during the underlying hearing. In most cases, the NPDB does not care about that argument. It isn't reviewing whether the original decision was fair or correct. It's reviewing whether the reportable action the entity described actually happened, and whether it was required to be reported at all. For example, if you were reported after an adverse privileging action, the NPDB will look at the entity's evidence and yours to determine whether an adverse privileging action occurred as the NPDB defines it, and whether it met the threshold for reportability under federal law. In other words, was the entity actually required to report it, or did they report it in error? Errors do happen, and that's exactly the kind of situation where a dispute is worth pursuing.

How the NPDB actually makes these determinations is not something laid out in plain language anywhere. You are not well advised to navigate this alone. Bring in an expert, and bring in a lawyer.

A Void Worth Remembering

Reports do get voided. It's a seldom occurrence, but it is possible with the right person on your team. I once saw a report voided in a case where, on its face, it didn't look like it should have been. It came down to one particular fact that, alone, was enough to make the report's accuracy legitimately disputable. Having someone in your corner who knows how to find that fact, and how to frame it, can make an enormous difference.

If You Want to Discuss Your Situation

If you'd like to talk through your specific report or get help navigating this process, please reach out. I can share my perspective on what to look for in an attorney if I were disputing a report myself, and our office can do a substantial amount of the underlying workup to hand off to your lawyer, consistent with our Terms of Engagement.

Claudia M. Rausch is not an attorney and does not practice law. This post reflects general regulatory and policy commentary based on professional experience and does not constitute legal advice. For legal advice specific to your situation, please consult a licensed attorney.

References

• 45 CFR Part 60 (NPDB implementing regulations)
• Title IV of P.L. 99-660, Health Care Quality Improvement Act of 1986, as amended
• Section 1921 of the Social Security Act (Section 5(b) of P.L. 100-93, the Medicare and Medicaid Patient and Program Protection Act of 1987, as amended)
• Section 1128E of the Social Security Act (P.L. 104-191, the Health Insurance Portability and Accountability Act of 1996)
• NPDB Guidebook, Chapter F: Subject Statements and the Dispute Process, Dispute Process
• NPDB Guidebook, Chapter F: Subject Statements and the Dispute Process, Prerequisites for Dispute Resolution
• NPDB Guidebook, Chapter F: Subject Statements and the Dispute Process, Dispute Resolution Limitations
• NPDB Guidebook, Chapter F: Subject Statements and the Dispute Process, Reconsideration of a Dispute Resolution Decision

Have Questions?

Claudia M. Rausch

The rules governing licensed practitioners, hospitals, and federal reporting were not designed to be legible to outsiders. If you are navigating a situation and need help understanding what the rules actually require — this is where to start. You do not need to already understand the system to reach out.

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