Healthcare Integrity and Protection Data Bank (HIP-DB) and the National Practitioner Data Bank (NPDB)

Congress established two separate programs to encourage the peer review process, improve the quality of health care, and combat fraud and abuse in health insurance and health care delivery.

The HIP-DB is the program that will most likely impact the respiratory therapy professional. The national data collection program for the reporting and disclosure of certain final adverse actions taken against health care providers, suppliers, or practitioners can be used as the nationwide flagging system. The system may primarily alert users to comprehensively review providers, suppliers, or practitioners past actions.

The HIP-DB contains the following types of information:

• Civil judgments against health care providers, suppliers, or practitioners in Federal or State court related to the delivery of a health care item or service;
• Federal or State criminal convictions against health care providers, suppliers, or practitioners related to the delivery of a health care item or service;
• Actions by Federal or State agencies responsible for the licensing and certification of health care providers, suppliers, or practitioners;
• Exclusions of health care providers, suppliers, or practitioners from participation in Federal or State health care programs; and
• Any other adjudicated actions or decisions against health care providers, suppliers, or practitioners that the Secretary establishes by regulations.

The HIP-DB provides another resource to assist federal and state agencies, state licensing boards, and health plans in conducting extensive, independent investigations of the qualifications of the health care providers, suppliers, or practitioners who they seek to license, hire, or credential, or with whom they seek to contract or affiliate.

The NPDB is a program primarily focused on the actions taken against physicians and dentists. (Although through a Congressional amendment other health care practitioners may also be reported.) NPDB contains information on medical malpractice payments, adverse licensure actions, clinical privilege actions, and professional society membership actions.

An excellent website to visit for more information on both these programs is www.npdb-hipdb.com