National Practitioner Data Bank (NPDB)
Authorizing Legislation: Title IV of Public Law 99-660
Regulations: 45 CFR part 60
The Health Care Quality Improvement Act of 1986 created a federal data bank for tracking information about physicians and dentists. The legislation was intended to encourage the peer review process, encourage the identification of incompetent or unprofessional practitioners and restrict their ability to move from state to state without disclosure or discovery of previous damaging or incompetent practice.
The NPDB contains information on adverse licensure actions, clinical privileges actions, and professional society actions taken against physicians and dentists. Additionally, the NPDB collects reports of medical malpractice payments made on behalf of all health care practitioners, including nurses.
Additional Congressional Legislation passed in 1987 expanded the NPDB to include adverse licensure actions about other health care practitioners, including nurses. However, this legislation has not yet been implemented.
Healthcare Integrity and Protection Data Bank (HIPDB)
Authorizing Legislation: Section 1128E of the Social Security Act, established by section 221(a) Public Law 104-191
Regulations: 45 CFR part 61
The Health Insurance Portability and Accountability Act of 1996 directed the U.S. Secretary of the Department of Health and Human Services to create the Healthcare Integrity and Protection Data Bank (HIPDB). The purpose of the HIPDB is to combat fraud and abuse in health care insurance and health care delivery.
The HIPDB is a national data collection program for the reporting and disclosure of certain final adverse actions taken against health care providers, suppliers, and practitioners. It includes the following types of information about health care providers, suppliers or practitioners:
- Civil judgments in State or Federal court related to the delivery of a health care item or service
- Federal or State criminal convictions related to the delivery of a health care item or service
- Actions by Federal or State licensing and certification agencies
- Exclusions from participation in Federal or State health care programs
- Any other adjudicated actions or decisions as established in regulations
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