Patient Safety | 07.27.21
Ten Things You Might Not Know About Submitting Medical Malpractice Payments Reports to the NPDB
The National Practitioner Data Bank is a web-based repository of reports containing information on medical malpractice payments and certain adverse actions related to health care practitioners, providers, and suppliers. Established by Congress in 1986, the NPDB is a workforce tool that prevents practitioners from moving state to state without disclosure or discovery of previous damaging performance. It assists in promoting quality health care and deterring fraud and abuse within health care delivery systems.
Medical Malpractice Payment Reporting Requirements
Medical malpractice payments are limited to exchanges of money and must be the result of a written complaint or claim demanding monetary payment for damages. The written complaint or claim must be based on a practitioner's provision of or failure to provide health care services. A written complaint or claim can include, but is not limited to, the filing of a cause of action based on tort law in any state or federal court or other adjudicative body, such as a claims arbitration board. Eligible entities must report when a lump sum payment is made or when the first of multiple payments is made.
Medical Malpractice Payment Reporting Facts
A medical malpractice payment should be submitted to the NPDB when it is made in satisfaction, in whole or in part of, a written claim or judgment for medical malpractice against a practitioner
The NPDB Guidebook has guidelines that help payers decide whether to report medical malpractice payments
Reports need to be submitted accurately and on time
Our data analysis tool can help display trends in reporting
Medical Malpractice Payment Reporting Statistics
On average the NPDB received approximately 11,000 Medical Malpractice Payment Reports (MMPRs) annually from 2016 to 2020. (The following statistics cover only the 2016 to 2020 period). These MMPRs make up approximately 21 percent of all NPDB reports. They are the second most common type of reports in the NPDB, after state licensure reports, which account for 72 percent of all NPDB reports. Approximately 22 percent of payment amounts were less than $50,000, while about two percent were $2,000,000 or more. MMPRs with the highest payments are attributed to death, then minor temporary injury, and significant permanent injury. For more information on medical malpractice payments reports data, see the charts accompanying this article – Figures 1, 2, and 3.
Ten Things You Might Not Know About MMPRs:
1. Payments not made in connection with litigation (e.g., those made resulting from professional peer review proceedings) may need to be reported. Peer review committees and others investigating and resolving patient complaints against practitioners should consider notifying practitioners of reporting requirements before a payment is made.
2. A payment made as a result of a lawsuit or claim solely against an entity (for example, a hospital, clinic, or group practice) that does not name, identify, or otherwise describe an individual practitioner should not be reported to the NPDB. Medical malpractice payments made solely for the benefit of a corporation – such as a clinic, group practice, or hospital – should not be reported to the NPDB. A payment made for the benefit of a professional corporation or other business entity that consists of only a sole practitioner must be reported if the payment was made by the entity rather than by the sole practitioner out of personal funds.
3. Not all MMPRs are created the same. As stated in Title IV of the Health Care Quality Improvement Act of 1986 and in NPDB regulations at 45 CFR § 60.7(d), a “payment in settlement of a medical malpractice action or claim shall not be construed as creating a presumption that medical malpractice has occurred.” Some medical malpractice claims (particularly those referred to as nuisance claims) may be settled for convenience and, as such, are not a reflection on the professional competence or professional conduct of a practitioner.
4. Confidential terms of a settlement or judgment do not excuse an entity from the statutory requirement to both report a payment to the NPDB and provide a narrative describing the payment. The reporting entity should explain in the narrative section of the MMPR that the settlement or court order stipulates that the terms of the settlement are confidential.
5. A waiver of a debt is not considered a payment and should not be reported to the NPDB. For example, if a patient has an adverse reaction to an injection and is willing to accept a waiver of fee as settlement, that waiver should not be reported to the NPDB.
6. Self-insured entities have the same reporting responsibilities as all other medical malpractice payers. Employers that are self-insured and provide their employees professional liability coverage must report medical malpractice payments made for the benefit of their employees.
7. A medical malpractice payment does not have to exceed a certain dollar amount before it is reportable to the NPDB. There is no minimum payment amount threshold. Medical malpractice payments of any amount that meet the reporting criteria should be reported to the NPDB.
8. The time frame for reporting medical malpractice payments to the NPDB is within 30 days of the initial payment, stating the total amount awarded. Payers must report when a lump sum payment is made or when the first of multiple payments is made. Additionally, reports must be submitted late if it is discovered they weren’t filed timely. In fact, federal statutes require that a report be filed, even if it is filed late.
9. A payer making an initial partial payment must report that payment to the NPDB even if a total amount has not been determined. Complete the MMPR screens on the secure NPDB website according to the instructions. Note the amount of the first payment and, in the narrative section, explain that the total amount has not been determined and the first payment is a partial payment. When the final amount is determined, submit a Correction Report, update the “Total Amount Paid” section of the report, and explain the additional payment in the narrative section.
10. After unsuccessful treatment, a patient and doctor enter into a state-sponsored voluntary discussion in an attempt to settle their disagreement before resorting to litigation, but during these discussions the practitioner’s insurance company makes a payment to the patient to settle the dispute. If, during the course of discussions, the patient made a written complaint or written claim demanding payment for damages, the payment must be reported. If the complaint or claim for damages was never put in writing, the payment is not reportable. A written complaint or claim can include, but is not limited to, the filing of a cause of action based on the law of tort in any state or federal court or other adjudicative body, such as a claims arbitration board. It must demand monetary payment for damages.
We hope this information is useful to you. The reporting of medical malpractice payments to the NPDB is one of the ways the NPDB helps protect patients and fight medical fraud and abuse. For more information, visit the NPDB website. You can also view our MMPR infographic. For questions about reporting or any other topic, contact the Customer Service Center at firstname.lastname@example.org or 800-767-6732. The hours of operation for the NPDB Customer Service Center are Monday – Thursday, 8:30 a.m. to 6:00 p.m., and Friday, 8:30 a.m. to 5:30 p.m., ET. The Customer Service Center is closed on weekends and federal holidays.