NATIONAL PRACTIONER DATA BANK (NPDB)
HEALTHCARE INTEGRITY AND PROTECTION DATABANK (HIPDB)
Title IV of Public Law 99-660, the Health Care Quality Improvement Act of 1986, as amended, established the National Practitioner Data Bank (NPDB) as an information clearinghouse to collect and release certain information related to the professional competence and conduct of physicians, dentists, and, in some cases, other healthcare practitioners. Originally the operations of the NPDB were directed only toward collecting and releasing information under Title IV. However, in 1987 Congress passed Public Law 100-93, Section 5 of the Medicare and Medicaid Patient and Program Protection Act of 1987 (Section 1921 of the Social Security Act), authorizing the Government to collect information concerning sanctions taken by State licensing authorities against all healthcare practitioners and entities.
Section 1921 was enacted to provide protection from unfit healthcare practitioners to beneficiaries participating in the Social Security Act’s healthcare programs and to improve the anti-fraud provisions of these programs. Congress later amended Section 1921 with the Omnibus Budget Reconciliation Act of 1990, Public Law 101-508, to add “any negative action or finding by such authority, organization, or entity regarding the practitioner or entity.” The U.S. Department of Health and Human Services (HHS) issued a Notice of Proposed Rulemaking for Section 1921 on March 21, 2006 and issued the Final Rule for Section 1921 of the Social Security Act as published in the Federal Register on January 28, 2010. The Data Banks opened Section 1921 for reporting and querying on March 1, 2010.
Section 1921 expands the information collected and disseminated through the NPDB to include reports on all licensure actions taken against all healthcare practitioners, not just physicians and dentists, as well as healthcare entities. Peer Review Organizations and Private Accreditation Organizations must report any negative actions or findings taken against healthcare practitioners or organizations. Queries have access to State licensure actions taken against all healthcare practitioners and Section 1921 provides limited querying by Quality Improvement Organizations, Federal and State Healthcare Programs, State Medicaid Fraud Control Units and other law enforcement agencies. Section 1921 also will allow entities new to the NPDB to access Section 1921 data through the NPDB.