The National Practitioner Data Bank (“NPDB”) has been in operation since 1990, its quirky reporting mandates  exceptional even amongst myriad regulatory hassles imposed on physicians.  NPBD finalized changes to its Guidebook (  warranting changes in medical staff bylaws to prevent needless, irreparable damage to physicians.

Investigation The Health Care Quality Improvement Act requires reporting a physician’s surrender of medical staff membership or privileges while under investigation, to prevent forced resignation in lieu of a NPDB report as a plea bargain.   The new Guidebook expands the investigation timeline, stating “An investigation begins as soon as the health care entity begins an inquiry and does not end until the health care entity’s decision-making authority takes a final action or makes a decision to not further pursue the matter.” Thus, a section chief checking a physician’s file following a patient’s complaint could trigger reportability.

Notice This expanded definition of investigation becomes more dangerous given that the Guidebook repeatedly states that the physician need not have any notice, indeed, need not even be aware, of an investigation. Further, the physician’s resignation is reportable even if it is just coincidental, and wholly unrelated, to the reasons for the secret investigation.   

Surrender Surrender of membership or privileges is interpreted to include opting not to reapply, or even exercising the right to a leave of absence.  Surrender and investigation do not have to be related.  Thus, deciding to forego a minor privilege on the biannual reapplication would cause a report, if an “investigation,” although unrelated to that privilege, is underway. A 6-week maternity leave could result in a NPDB report if, unbeknownst to the pregnant physician, any inquiry into her practice has begun.

Investigation Although the Data Bank ultimately determines when an investigation began, delineating in bylaws what is and is not an investigation should set practical parameters.

Notice Bylaws should stipulate that physicians receive written notice of any investigation.

Surrender Physicians should be authorized to receive a written statement as to whether there is an ongoing investigation prior to resigning any privileges, reapplying, or taking any leave of absence longer than 30 days.

The Guidebook addresses other NPDB reporting and querying requirements for malpractice payments and licensure and medical society actions.   For further information, contact Libby Snelson at