How to Manage Findings on an NPDB Query

We are in the process of credentialing and privileging a new physician. When we ran the National Practitioner Data Bank (NPDB) Query, a finding was noted. Do you have any suggestions as to how we should address this?

The NPDB is an online repository of reports containing information on medical malpractice payments and adverse actions associated with health care practitioners, providers and suppliers.   The goal of the NPDB is to ensure the delivery of care by competent, qualified individuals and reduce health care fraud and abuse.

As outlined in The Health Resources and Services Administration (HRSA) Health Center Program Compliance Manual, Chapter 5 – Clinical Staffing (Chapter 5 – Clinical Staffing) and Federal Tort Claims Act (FTCA) Health Center Policy Manual (FTCA Policy Manual), health centers are required to run an NPDB Query on all Clinical Staff, which includes Licensed Independent Practitioners (LIPs), Other Licensed and Certified Practitioners (OLCPs) and Other Clinical Staff (OCS).  The NPDB must be queried upon initial hire and on a recurring basis, which is typically a period of every two years. 

It is at the discretion of the health center to determine the process for managing findings on an NPDB Query.  Many health centers will not hire an individual with NPDB findings, although a significant number utilize an objective approach with the candidate.  The following factors should be considered when a query of the NPDB generates findings:

  • Review the organization’s policy to determine whether findings on an NPDB Query automatically eliminate a candidate from the hiring process.
  • Review the candidate’s application to see if and what information was disclosed. 
  • Consider the nature and date of the occurrence.
  • Determine whether the candidate can be hired with modified privileges (i.e., limited prescription privileges).

Most importantly, talk with the candidate about the situation to obtain more details that can assist with the decision-making process.  Once all the above information is collected, collaborate with leadership to determine the appropriate course of action.

Additional information regarding the NPDB Query can be found at (The National Practitioner Data Bank).

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