National Practitioner Data Bank (NPDB) Update

On March 23, 2010, President Barack Obama signed into law the Patient Protection and Affordable Care Act (PPACA).  This legislation made many reforms to the American health care system and with it came many changes that will affect both health care providers and consumers alike.  One such change brought about by this legislation was the elimination of the independent Health Integrity and Protection Data Bank (HIPDB), and its merger with the National Practitioner Data Bank (NPDB).  This will not affect the purpose of the federal government’s clearing house for disciplinary and malpractice information, but will forever change how the information is disseminated.

 To understand the changes, one must first know the history of the NPDB.  The NPDB was established by Title IV of Public Law 99-660, of the Health Care Quality Improvement Act of 1986.  Its purpose was to improve the quality of health care by encouraging State licensing boards, hospitals and other health care entities, and professional societies to identify and discipline those who engage in unprofessional behavior.  The NPDB has been expanded and revised a number of times, but its greatest expansion came on January 28, 2010, when the U.S. Department of Health and Human Services issued a final rule implementing Section 1921 of the Social Security Act. 

Prior to this the NPDB dealt only with licensure and malpractice reports of physicians, dentists, and health care entities. This new regulation expanded the information collected and disseminated through the NPDB to include reports on all licensure actions taken against all health care practitioners.

Like the NPDB, the HIPDB was created to improve the quality of healthcare in America.  The HIPDB was formed under the Health Insurance Portability and Accounting Act of 1996 (HIPAA) and  specifically focused on combating fraud and abuse in health insurance and health care delivery, and promoting quality care.  The HIPDB collected reports made by federal and state licensing agencies, federal and state prosecutors, and federal and state government agencies that had excluded a practitioner, provider or supplier from their health plan.

The NPDB and the HIPDB were created to provide a resource for state licensing boards, hospitals, and other health care entities to assist them in their investigations of the qualifications of the healthcare practitioners they sought to license or hire.  These two data banks served this purpose independently of each other until the passing of PPACA on March 23, 2010.

Section 6403 of PPACA requires the Secretary of Health and Human Services (HHS) to maintain a national health care fraud and abuse data collection program for reporting certain adverse actions taken against health care providers, suppliers, and practitioners, and to submit information on the actions to the NPDB.  Section 6403 further requires the Secretary to establish a process to terminate the HIPDB and ensure that the information formerly collected in the HIPDB is transferred to the NPDB.

What does this mean to you?  Specifically, the NPDB has now become one large, all encompassing central data bank for all reports made against all health care professionals, whether the report deals with fraud, abuse, licensure actions, or malpractice.  The HIPDB has been eliminated as an independent data bank and in its place the Secretary of Health and Human Services has implemented a process in which all fraud and abuse reports will be collected and transferred to the NPDB.  Additionally, all information that was previously held in the HIPDB has been transferred to the NPDB.

For more information about the National Practitioner Data Bank and how it might impact you and your practice, visit www.TheHealthLawFirm.com.

Florida Doctor Arrested for Drug Sales and Other Criminal Charges

Drug trafficking charges against a medical doctor are not a new concept, especially in Florida. Recent pill mill busts throughout the state have resulted in an omnipresent DEA, always on the lookout for illegal drug sales by pharmacies, pharmacists, pain management clinics and physicians. However, the recent arrest of a Central Florida doctor extends beyond the run of the mill “pill mill” bust, as the accusations in this case involve sex with a minor and delivering a controlled substance to a minor.

According to Florida Today, this Central Florida doctor was arrested Tuesday following a raid by the Florida Department of Law Enforcement. This is his second arrest after he was charged with possession of marijuana and drug paraphernalia in August.

Tuesday’s arrest resulted from evidence of the doctor’s sexual relationship with a high school student. The doctor was arrested in 2009 after being caught during a traffic stop with bags of marijuana in his car and allegedly having a sexual relationship with the 16-year-old passenger. Although charges were not filed after the girl recanted her evidence and claimed the marijuana was hers, that didn’t put an end to a steady stream of younger girls going into the clinic. According to residents of the area surrounding the clinic, girls were frequently seen going to see the doctor dressed in revealing attire. Aside from teenage patients, residents reported often seeing a line out to the street for people waiting to get into the clinic, a possible indicator of drug trafficking.

Although his medical license has been suspended, this Florida doctor has yet to receive broader drug trafficking charges, despite his huge prescription distribution numbers. According to the Florida Department of Law Enforcement, this doctor prescribed 250,000 oxycodone pills in the first eight months of 2011. Compared to the entire state of California, which had 300,000 oxycodone prescriptions in the last six months of 2010, it is evident that this Florida doctor had a major painkiller operation. The Florida Department of Law Enforcement is calling him one of the worst offenders in the state of Florida. Upon further investigation, this doctor and anyone who may have assisted him in the drug trafficking of oxycodone may be charged for this offense.

While the possibility of drug trafficking charges is enough to scare any physician, other criminal charges can be equally damaging, especially depending on how the accused individuals plea to the charges. A health professional’s plea of nolo contendere, which may seem like the safe route, is actually treated the same as a plea of guilty for all purposes. There are ways to defend criminal charges (like the ones against the aforementioned Florida doctor) that can result in a more favorable outcome (e.g., attempting to obtain pre-trial diversion, pre-trial intervention or drug court), but legal advice should be sought from an attorney who frequently represents health care providers before any actions are pursued. To learn more about criminal charges against doctors and other health professionals see this recent post or visit our website at www.TheHealthLawFirm.com.