ISMIE's Approach to NPDB Reporting Requirements
When a claim payment is made on behalf of a policyholder (physician or other healthcare practitioner), ISMIE, as a reporting entity is mandated by the National Practitioner Data Bank (NPDB) to submit a Medical Malpractice Payment report within 30 days of said payment. Failure to do so can result in a fine (up to $10,000) for each such missing report.
This requirement is applicable to any practitioner who is licensed or otherwise authorized by the state to provide health care services. The report is submitted simultaneously to the appropriate state licensing board in the state in which the claim occurred. The reports are required to be submitted whether the matter was settled due to judgment, out of court settlement or arbitration.
As a reporting entity, ISMIE must provide an accurate description of the acts and/or omissions and injuries or illnesses upon which the medical liability action or alleged claim was based.
ISMIE extends the courtesy of allowing you the opportunity to see a working copy of the report before the final report is submitted to the NPDB. While we are mandated by law to report, we want you to feel comfortable with the information being submitted.
Within 30 days after submitting the report to the NPDB, you will receive notification from the data bank that the report was received. At that time, you are offered the opportunity to submit a Subject Statement (https://www.npdb.hrsa.gov/pract/howToSubmitAStatement.jsp). This response is encouraged as it allows the insured an opportunity to explain the circumstances of the incident being reported. The statement can be up to 4,000 characters and may be submitted at any time. Once processed, this statement becomes part of the report. The updated report will be sent to the reporting entity as well as all authorized queriers who received the report within the past 3 years. The statement will also be included with the report when it is released to future authorized queriers. A subject of the report may modify, or remove a Subject Statement at any time through the NPDB's Report Response Services.
The information in the NPDB serves only to alert state licensee authorities and health care entities that there may be a problem with a particular practitioner's professional competence or conduct. The Privacy Act protects the contents from the general public and medical liability payors. Information reported to the NPDB is considered confidential and is only available to queriers as authorized by law. Some authorized queriers include:
- Hospitals requesting information concerning a practitioner on its medical staff.
- Health care entities (including hospitals) that have entered or may be entering an employment agreement with a physician.
- Practitioners requesting information about themselves.
- Medical examiners or other state licensing boards.
You can contact the National Practitioner Data Bank at http://www.npdb.hrsa.gov.