Fight Back in National Practitioner Data Bank Disputes and Appeal Adverse Reports

By George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The National Practitioner Data Bank (NPDB), created in 1986, was part of the Health Care Quality Improvement Act (HCQIA). Its purpose is to improve the quality of health care by encouraging state licensing boards, hospitals, health care entities, and professional societies to report into a national data bank those physicians and health professionals who demonstrate substandard skills or engage in unprofessional behavior.  In part, it is used to make sure that incompetent physicians do not move from one state to another in order to avoid the consequences.

Adverse Reports Stay in the NPDB for Life.

How long does an adverse NPDB report stay in the Data Bank?  I have received two (2) different answers to this question from different authorities.  I was originally informed that adverse NPDB reports are for life, and believed that for my first 25 or so years of practice.  However, more recently I have been informed that they only stay in the Data Bank for 50 years.  However, there is little difference whether it is actually 50 years or for life.  For most physicians 50 years is a lifetime for a medical career.

A Negative NPDB Report Has the Ability to Ruin Your Career.

All reports in the NPDB on an individual can and are queried by state licensing boards, hospitals, and other health care facilities to assist in investigating adverse incidents and disciplinary actions that may have been taken against a physician applying for a license or clinical privileges. Therefore, adverse NPDB reports can have long-lasting, devastating effects on the career of a health care provider.

Additionally, the real-world consequences of being the subject of an NPDB report include possible exclusion from the panels of health plans and independent physician organizations, termination for cause from state Medicaid programs, loss of medical staff privileges at hospitals and health facilities, increases in professional liability insurance premiums, exclusion from the Medicare Program, and additional licensing investigations and potential discipline by other organizations and states.

If you are the subject of an adverse NPDB report, there are several actions you should take to correct any errors, provide your side of the facts, and possibly have the adverse report removed or corrected.

What Happens If You Disagree With Your Report?

Reports to the NPDB are, for all practical purposes for life, as explained above.  But healthcare professionals may appeal adverse reports through a dispute resolution process involving the Secretary of the Department of Health and Human Services (HHS). You can dispute reports if you disagree with factual accuracy of the report or if the event reported are not proper under NPDB guidelines.  For example, getting fired from a job or having a contract terminated for cause are not proper events to cause an adverse NPDB report. We have had to represent physicians in the past having these types of reports removed from the NPDB.

It’s important to note that entering the report into dispute status does not automatically trigger a review. When in dispute status, you have to notify the reporting organization.  The reporting organization can correct, void, or choose to leave the report unchanged. If after 60 days you have received no response from the reporting organization, or you are unsatisfied with the response you received, you can elevate the report to dispute resolution (appeal).

Visit the NPDB website here for more details on this process.

For more reference, you can see what a successful voided NPDB report looks like here. This example results from The Health Law Firm’s recent successful appeal of an adverse NPDB report for a client.

Your Career May Depend On Having Legal Counsel Who Understands the NPDB.

If you have received a negative National Practitioner Data Bank report and wish to appeal it, contact The Health Law Firm. Our attorneys routinely represent physicians, dentists, and other healthcare professionals in disputing and appealing NPDB reports. To learn more, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.

The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists, and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. Its attorneys include those who are board-certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

NPDB Disputes and Appeals: Fight Back Against Adverse Reports

Attorney and Author HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

The National Practitioner Data Bank (NPDB), created in 1986, was part of the Health Care Quality Improvement Act (HCQIA). Its purpose is to improve the quality of health care by encouraging state licensing boards, hospitals, health care entities, and professional societies to report into a national data bank those physicians and health professionals who demonstrate substandard skills or engage in unprofessional behavior. In part, it is used to make sure that incompetent physicians do not move from one state to another in order to avoid the consequences.

Adverse Reports Stay in the NPDB for Life.

How long does an adverse NPDB report stay in the Data Bank? I have received two (2) different answers to this question from different authorities. I was originally informed that adverse NPDB reports are for life, and believed that for my first 25 or so years of practice. However, more recently I have been informed that they only stay in the Data Bank for 50 years. However, there is little difference whether it is actually 50 years or for life. For most physicians, 50 years is a lifetime for a medical career.

 

A Negative NPDB Report Has the Ability to Ruin Your Career.

All reports in the NPDB on an individual can and are queried by state licensing boards, hospitals, and other health care facilities to assist in investigating adverse incidents and disciplinary actions that may have been taken against a physician applying for a license or clinical privileges. Therefore, adverse NPDB reports can have long-lasting, devastating effects on the career of a health care provider.

Additionally, the real-world consequences of being the subject of an NPDB report include possible exclusion from the panels of health plans and independent physician organizations, termination for cause from state Medicaid programs, loss of medical staff privileges at hospitals and health facilities, increases in professional liability insurance premiums, exclusion from the Medicare Program, and additional licensing investigations and potential discipline by other organizations and states.

If you are the subject of an adverse NPDB report, there are several actions you should take to correct any errors, provide your side of the facts, and possibly have the adverse report removed or corrected.

What Happens If You Disagree With Your Report?

Reports to the NPDB are, for all practical purposes for life, as explained above. But healthcare professionals may appeal adverse reports through a dispute resolution process involving the Secretary of the Department of Health and Human Services (HHS). You can dispute reports if you disagree with factual accuracy of the report or if the event reported are not proper under NPDB guidelines. For example, getting fired from a job or having a contract terminated for cause are not proper events to cause an adverse NPDB report. We have had to represent physicians in the past having these types of reports removed from the NPDB.

It’s important to note that entering the report into dispute status does not automatically trigger a review. When in dispute status, you have to notify the reporting organization. The reporting organization can correct, void, or choose to leave the report unchanged. If after 60 days you have received no response from the reporting organization, or you are unsatisfied with the response you received, you can elevate the report to dispute resolution (appeal).

Visit the NPDB website here for more details on this process.

For more reference, you can see what a successful voided NPDB report looks like here.  This example results from The Health Law Firm’s recent successful appeal of an adverse NPDB report for a client.

Your Career May Depend On Having Legal Counsel Who Understands the NPDB.

If you have received a negative National Practitioner Data Bank report and wish to appeal it, contact The Health Law Firm. Our attorneys routinely represent physicians, dentists, and other healthcare professionals in disputing and appealing NPDB reports. To learn more, click here to read one of my prior blogs.

Don’t Wait Until It’s Too Late, Contact Experienced Health Law Attorneys.

The Health Law Firm attorneys routinely represent physicians, physician assistants (PAs), nurses, nurse practitioners (NPs), dentists and other health professionals in dealing with reports being made to the NPDB, disputing NPDB reports and appealing NPDB reports, hospital clinical privileges hearings, medical staff fair hearings, medical staff peer reviews. Its attorneys include those who are board certified by The Florida Bar in Health Law as well as licensed health professionals who are also attorneys.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free (888) 331-6620 and visit our website at http://www.TheHealthLawFirm.com.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave., Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

Florida Surgeon Gets 7 Years for Committing $28 Million in Health Care Fraud

Attorney HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. The scheme involved performing hundreds of medically unnecessary, invasive surgical procedures on his patients.

The defendant, a dual citizen of the United States and Ghana, pled guilty to all 58 counts against him in federal court on December 18, 2020. Jason R. Cody, Acting United States Attorney for the Northern District of Florida, announced the sentence. Read more about the sentencing here.

Compromising the Health and Safety of Patients For Illegal Profit.

For almost four years, beginning in 2016 until his arrest in February 2020, it is alleged that the surgeon solicited his victims by establishing relationships with churches, nursing homes, hospitals, and outreach organizations. The 58-count indictment alleges the surgeon defrauded Medicare and Medicaid by billing for dozens of procedures that he never performed. A detailed list shows each claim was for more than $21,000. Federal prosecutors said that the claims that were improperly billed reached $23 million.

A later motion filed by the government alleges that the doctor’s calendar showed that he performed 14 surgeries in one day.

In addition to performing unnecessary surgical procedures, the doctor was accused of victimizing others by falsifying their medical records to reflect surgical procedures that he did not perform. He created erroneous and misleading medical records that could cause doctors who treated the same patients in the future to commit errors in their treatment of the same patients.

The Consequences of the Surgeon’s Actions.

In addition to prison time, the sentence included forfeiture of the surgeon’s assets in the United States and overseas. The assets included luxury vehicles, jewelry, and homes located in Manhattan, Miami, and Houston. The court also ordered the payment of $28.4 million in restitution.

“Instead of caring for his patients, this defendant targeted vulnerable members of our community, subjected them to unnecessary surgical procedures, and falsified documents so he could line his pockets with millions of taxpayer dollars,” a law enforcement authority reportedly stated.

Click here to read the press release in full issued from the U.S. Department of Justice (DOJ) to learn more.

To read about a similar case involving another healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal defense representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists, and other health providers in healthcare fraud investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare and Medicaid investigations, Office of Inspector General (OIG) actions, Department of Health (DOH) investigations, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Paavola, Amy. “Florida physician gets 7-year sentence for $29M fraud scheme.” Becker’s Hospital Review. (November 18, 2021). Web.

AHLA. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” American Health Law Association. (December 3, 2021). Web.

Casey, Monica. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” WCTV. (November 18, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

Florida Surgeon Handed Seven Years in Prison for $28 Million Health Care Fraud Scheme

George Indest HeadshotBy George F. Indest III, J.D., M.P.A., LL.M., Board Certified by The Florida Bar in Health Law

On November 18, 2021, a Tallahassee surgeon was sentenced to seven years in federal prison for committing health care fraud, conspiracy to commit health care fraud, and aggravated identity theft. The scheme involved performing hundreds of medically unnecessary, invasive surgical procedures on his patients.

The defendant, a dual citizen of the United States and Ghana, pled guilty to all 58 counts against him in federal court on December 18, 2020. Jason R. Cody, Acting United States Attorney for the Northern District of Florida, announced the sentence. Read more about the sentencing here.

Compromising the Health and Safety of Patients For Illegal Profit.

For almost four years, beginning in 2016 until his arrest in February 2020, it is alleged that the surgeon solicited his victims by establishing relationships with churches, nursing homes, hospitals, and outreach organizations. The 58-count indictment alleges the surgeon defrauded Medicare and Medicaid by billing for dozens of procedures that he never performed. A detailed list shows each claim was for more than $21,000. Federal prosecutors said that the claims that were improperly billed reached $23 million.

A later motion filed by the government alleges that the doctor’s calendar showed that he performed 14 surgeries in one day.

In addition to performing unnecessary surgical procedures, the doctor was accused of victimizing others by falsifying their medical records to reflect surgical procedures that he did not perform. He created erroneous and misleading medical records that could cause doctors who treated the same patients in the future to commit errors in their treatment of the same patients.

The Consequences of the Surgeon’s Actions.

In addition to prison time, the sentence included forfeiture of the surgeon’s assets in the United States and overseas. The assets included luxury vehicles, jewelry, and homes located in Manhattan, Miami, and Houston. The court also ordered the payment of $28.4 million in restitution.

“Instead of caring for his patients, this defendant targeted vulnerable members of our community, subjected them to unnecessary surgical procedures, and falsified documents so he could line his pockets with millions of taxpayer dollars,” a law enforcement authority reportedly stated.

Click here to read the press release in full issued from the U.S. Department of Justice (DOJ) to learn more.

To read about a similar case involving another healthcare professional, click here to read my prior blog.

Contact Health Law Attorneys Experienced with Investigations of Health Professionals and Providers.

The attorneys of The Health Law Firm provide legal defense representation to physicians, nurses, nurse practitioners, CRNAs, dentists, pharmacists, psychologists and other health providers in healthcare fraud investigations, Drug Enforcement Administration (DEA) investigations, FBI investigations, Medicare and Medicaid investigations, Office of Inspector General (OIG) actions, Department of Health (DOH) investigations, and other types of investigations of health professionals and providers.

To contact The Health Law Firm, please call (407) 331-6620 or Toll-Free at (888) 331-6620 and visit our website at www.TheHealthLawFirm.com.

Sources:

Paavola, Amy. “Florida physician gets 7-year sentence for $29M fraud scheme.” Becker’s Hospital Review. (November 18, 2021). Web.

AHLA. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” American Health Law Association. (December 3, 2021). Web.

Casey, Monica. “Florida Surgeon Draws Seven-Year Prison Term for $28 Million Health Care Fraud.” WCTV. (November 18, 2021). Web.

About the Author: George F. Indest III, J.D., M.P.A., LL.M., is Board Certified by The Florida Bar in Health Law. He is the President and Managing Partner of The Health Law Firm, which has a national practice. Its main office is in Orlando, Florida, area. www.TheHealthLawFirm.com The Health Law Firm, 1101 Douglas Ave. Suite 1000, Altamonte Springs, FL 32714, Phone: (407) 331-6620 or Toll-Free: (888) 331-6620.

“The Health Law Firm” is a registered fictitious business name of and a registered service mark of The Health Law Firm, P.A., a Florida professional service corporation, since 1999.
Copyright © 2022 The Health Law Firm. All rights reserved.

 

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