National Practitioner Data Bank:

Major Improvements Are Needed to Enhance Data Bank's Reliability

GAO-01-130: Published: Nov 17, 2000. Publicly Released: Nov 30, 2000.

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Although the National Practitioner Data Bank is presently the nation's only central source of medical malpractice payment information, it is unclear whether all relevant data are being properly reported. GAO's review suggests that information in that data bank may not be as accurate, complete, or as timely as it should be. Inaccuracies in the way reported information was coded could confuse or mislead querying organizations about the severity of actions taken against practitioners. Also, duplicate reports overstate the amount of information that the databank has on a particular practitioner. The Health Resources and Services Administration (HRSA) has not established criteria for the information that states and other entities must report when notifying the data bank of the disciplinary actions taken. Moreover, HRSA lacks procedures for ensuring that reporters adhere to the criteria established for medical malpractice reports, including inappropriate references to patients' names. Furthermore, the practitioner notification and dispute resolution processes have not ensured that inaccurate and erroneously reported information is removed from the data bank and not released to entities seeking information on specific practitioners. Finally, without an examination of its financial operations, HRSA has little assurance that its data bank user fees are appropriate. An analysis of its cash balances and cash flows--user fee collections and disbursements--would be the best way for HRSA to determine the appropriateness of fees.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: In August 2005, HRSA said that it checks reports for accuracy and completeness as far as this can be done by computer-based techniques and described its efforts to identify and correct errors. However, it noted it has no statutory authority to send investigators to review records and confirm the underlying accuracy and completeness of information reported to the NPDB. It did not indicate whether it would seek a legislative remedy to address this matter.

    Recommendation: The Administrator, HRSA, should develop procedures for routinely checking the accuracy and completeness of information reported to NPDB and for obtaining corrections from reporters, when necessary.

    Agency Affected: Department of Health and Human Services: Health Resources Administration

  2. Status: Closed - Not Implemented

    Comments: In August 2005, HRSA reported that it is considering improving reporting instructions to explicitly specify the elements to be included in the narratives. In addition, it is drafting new language to be included in the forthcoming edition of the NPDB Guidebook, which will explain the need and legal basis for adequate narratives.

    Recommendation: The Administrator, HRSA, should develop criteria for the information that should be included in the narrative sections of reports concerning disciplinary actions taken against practitioners.

    Agency Affected: Department of Health and Human Services: Health Resources Administration

  3. Status: Closed - Not Implemented

    Comments: In August 2005, HRSA stated that it has complied with the spirit of this recommendation and described its efforts to improve data reliability. However, HRSA maintains that its Strategic Plan is not the appropriate mechanism to address the NPDB.

    Recommendation: The Administrator, HRSA, should incorporate NPDB into the agency's strategic plan, including the measures needed to improve the reliability of reported information.

    Agency Affected: Department of Health and Human Services: Health Resources Administration

  4. Status: Closed - Not Implemented

    Comments: HRSA has concluded that incorporating information on disciplinary actions taken against nurses and other health care practitioners would significantly expand the availability of critical information to hospitals and other health care entities. HRSA reported that it submitted a Notice of Proposed Rulemaking (NPRM) to the Department for final review and approval in June 2004. If implemented, the NPRM would add such licensure information to the NPDB. Although HRSA reported that, in August 2005, it was in the final stages of complying with this recommendation, it did not mention the status of the NPRM and its outlook for approval.

    Recommendation: The Administrator, HRSA, should take immediate action to incorporate information on the disciplinary actions taken against nurses and other health care practitioners into NPDB.

    Agency Affected: Department of Health and Human Services: Health Resources Administration

  5. Status: Closed - Implemented

    Comments: In April 2002, HRSA reported that new internal controls have been implemented to ensure that obligations are authorized and disbursements supported. HRSA also pointed out that its core accounting system creates a clear audit trail and that it has received clean opinions from an independent accounting firm. HRSA, therefore, considers this recommendation to be fully implemented.

    Recommendation: To address underreporting, the Secretary of Health and Human Services should determine what resources and authorities are required to monitor and enforce compliance with NPDB's reporting requirements efficiently and effectively, and then seek the necessary legislative remedies to carry out these responsibilities. Additionally, the Secretary should require the Administrator of HRSA and the Director of the Division of Financial Operations to work to ensure that NPDB disbursements are adequately documented. This could be done by establishing internal controls that require original support and a clear audit trail for all disbursements.

    Agency Affected: Department of Health and Human Services

  6. Status: Closed - Implemented

    Comments: In April 2002, HRSA reported that it has established procedures to appropriately allocate user fees between the NPDB and the Healthcare Integrity Protection Data Bank. These procedures have been enhanced by newly installed software. As a result, HRSA considers this recommendation to be fully implemented.

    Recommendation: To address underreporting, the Secretary of Health and Human Services should determine what resources and authorities are required to monitor and enforce compliance with NPDB's reporting requirements efficiently and effectively, and then seek the necessary legislative remedies to carry out these responsibilities. Additionally, the Secretary should require the Administrator of HRSA and the Director of the Division of Financial Operations to work to develop procedures to ensure that user fees are properly allocated between NPDB and the Healthcare Integrity Protection Data Bank.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed - Implemented

    Comments: In April 2002, HRSA reported that it has modified its accounting systems to enable the tracking and reconciliation of all transactions. HRSA stated that by doing so it has established an audit trail and, therefore, considers this recommendation to be fully implemented.

    Recommendation: To address underreporting, the Secretary of Health and Human Services should determine what resources and authorities are required to monitor and enforce compliance with NPDB's reporting requirements efficiently and effectively, and then seek the necessary legislative remedies to carry out these responsibilities. Additionally, the Secretary should require the Administrator of HRSA and the Director of the Division of Financial Operations to work to develop procedures to ensure that all assessed user fees are collected, including: (1) establishing an audit trail of user fees from the NPDB system to the general ledger; and (2) periodically reconciling user fees.

    Agency Affected: Department of Health and Human Services

  8. Status: Closed - Not Implemented

    Comments: In August 2005, HRSA reported that it has taken steps to address adverse action reporting problems and that it refers allegations to the HHS-OIG when appropriate. HRSA noted that in 2001 it studied the extent to which health care entities and malpractice payers would voluntarily allow HRSA to inspect professional review and malpractice payment files. The results indicated that the vast majority of health care entities would not release the professional review materials underlying their decisions to report a practitioner to the NPDB. HRSA also noted that existing legislation is inadequate to compel them to do so, but did not indicate whether it would seek legislative remedies as GAO recommended. Regarding its financial planning efforts, HRSA reported that it develops and monitors financial plans for projecting expected program revenue, contract costs, and operating expenses annually. It also reported that it adjusts user fees based on these activities. However, it did not specifically address whether it has developed an annual financial plan or an annual assessment of the adequacy of the human capital and technical resources needed for NPDB operations.

    Recommendation: To address underreporting, the Secretary of Health and Human Services should determine what resources and authorities are required to monitor and enforce compliance with NPDB's reporting requirements efficiently and effectively, and then seek the necessary legislative remedies to carry out these responsibilities. Additionally, the Secretary should require the Administrator of HRSA and the Director of the Division of Financial Operations to work to develop an annual financial plan for projecting cash flows--including revenue, operating expenses, and capital investments--as a basis for the human capital and technical resources needed for the NPDB operations. Further, taking into consideration existing cash balances and projected cash flows, they should evaluate whether current user fees are appropriate.

    Agency Affected: Department of Health and Human Services

  9. Status: Closed - Not Implemented

    Comments: In 2004, HRSA reported that it continues to disagree that more warnings are needed. HRSA stated that NPDB already notifies users of its limitations and that the data bank was not intended to provide complete information about malpractice payments and adverse actions. HRSA also reported that the NPDB has added special flags to alert users to certain dated information. In August 2005, HRSA stated that it agrees that users should be aware of the limitations of the NPDB system, but did not indicate that it would revise the user notifications. It also mentioned steps it has taken to reduce confusion among users querying reports.

    Recommendation: The Administrator, HRSA, should revise NPDB user and practitioner notifications to include disclosures on the limitations of the data and warnings regarding duplicate submissions as an interim measure until procedures to monitor data quality are implemented.

    Agency Affected: Department of Health and Human Services: Health Resources Administration

 

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