Attorneys, have you ever been surprised by your medical expert’s admission under oath of a licensure sanction or major malpractice award?

licensure-sanction-major-malpractice-award-mls
Frankly, do you really know everything you should about your testifying Medical Experts? Like where they’ve been and what they’ve done in the past? Maybe, you’ve read
their Curriculum Vitae and relied on “Assumptive” or “Delegated” Credentialing by a hospital, medical school or insurer? You know, the “Dr. S. is on the faculty at the medical university, so I assume he’s been credentialed and has nothing egregious in his background” kind of knowing!

If you are not familiar with the National Practitioner Data Bank (NPDB), you certainly should be. See my resources and a great tip.

The NPDB was first established in 1986 as part of the Health Care Quality Improvement Act and is today an agency of the Centers for Medicare & Medicaid Services (CMS), Department of Health and Human Services (DHHS), Health Resources and Services Administration (HRSA), Office of Inspector General (OIG).

What you need to know is that over the years, the scope of the National Practitioner Data Bank has been expanded. Currently, reportable adverse events include:

• Medical Malpractice Payments

• Adverse clinical privileges (e.g. hospital staff/membership actions)

• Adverse professional society actions

• Adverse licensure actions on physicians and dentists and more recently nurses

• Drug Enforcement Administration (DEA) actions

• Medicare/Medicaid exclusions

• Negative actions or findings by State licensing authorities

• Negative actions or findings by peer review organizations and private accreditation organizations

And are reported by:

• Medical Malpractice Payers

• Boards of Medical/Dental Examiners

• Hospitals

• Other health care entities with formal peer review

• Professional Societies with formal peer review

• Office of Inspector General (OIG) and Drug Enforcement Administration (DEA)

• State agencies that license health care practitioners and entities

• Private accreditation organizations – e.g. Joint Commission, URAC, NCQA

With the more recent merger of the Healthcare Integrity and Protection Data Bank into the National Practitioner Data Bank, additional adverse “non-clinical malpractice” events are also being reported, such as:

• Health care-related criminal convictions

• Health care-related civil judgments

• Exclusions from Federal or State health care programs

• Federal and State licensure and certification actions

Unfortunately, and with little exception, Attorneys do not have direct access to NPDB.

There are very narrow requests in medical malpractice litigation that are accepted.

Well, here’s a tip you may not know about or didn’t know how easy it is to access!

Any practitioner may request a “self-query” and access their complete history. It is relatively easy to do, quite inexpensive ($8.00 per request), and frankly, every medical professional should know what is in his or her own file.

So, don’t be surprised when it is too late. To help, here are a couple of resources for you:

Practitioners-Self-Query Basics

http://www.npdb.hrsa.gov/pract/informationForAttorneys.jsp

Practitioners-Information for Attorneys

http://www.npdb.hrsa.gov/pract/informationForAttorneys.jsp

As a former Hospital Administrator, Rick Litzky, VP of Business Development at Medical Legal Spider, brings a unique perspective to our changing healthcare delivery system and effects on medical injury litigation. Please contact Rick directly to answer questions, request future research on a topic of your interest or to learn more about Medical Legal Spider’s innovative solutions for improving the medical review experience. He may be reached at 855-677-4337 or rlitzky@medicallegalspider.com

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