Disputing Reports and Secretarial Reviews
Subject Information in the Data Banks
When the NPDB-HIPDB receives a report, the information is processed
exactly as it was submitted by the reporting entity. Reporting entities
are responsible for the accuracy of the information they report
and the Data Banks are prohibited by law from modifying information
submitted in reports. When a report is processed, a Report Verification
Document is sent to the reporting entity, and a Notification of
a Report in the Data Bank(s) is sent to the subject.
Subjects should review the report for accuracy, including such
information as current address and place of employment. Subjects
may not submit changes to reports. If any information in a report
is inaccurate, the subject must contact the reporting entity to
request that it file a correction to the report. If the reporting
entity does not correct the information, the subject may add a statement
or dispute the accuracy of the report. To do this, a subject must
initiate a dispute through the Report Response
Service.
Reporting entities may reduce the likelihood of a subject disputing
a report by consulting with the practitioner, provider, or supplier
about the report prior to submitting it to the Data Bank(s).
Subject Statements
The subject of a report may add a statement to a report at any
time. When a statement is processed, a notification of the statement
is sent to all queriers who previously received the report, and
the statement will be included with the report when it is released
to future queriers. Subject Statements are limited to 4,000 characters,
including spaces and punctuation. Drafting a statement in accordance
with the character limits helps to ensure that the statement will
contain the information a subject considers most important. Subject
Statements must not include any patient names.
A Subject Statement becomes part of the specific report for which
it is filed. If the reporting entity subsequently corrects or changes
a report that contains a Subject Statement, the original statement
will be maintained in the modified report until the subject elects
to remove it or replace it with a new statement.
Subject Disputes
The subject of a Medical Malpractice Payment Report, an Adverse
Action Report, or a Judgment or Conviction Report may dispute either
the factual accuracy of the report or whether the report was submitted
in accordance with the NPDB’s or the HIPDB’s reporting requirements,
including the eligibility of the entity to report the information
to the Data Bank(s). A subject may not dispute a report in order
to protest a decision made by an insurer to settle a claim or to
appeal the underlying reasons for an adverse action, or judgment
or conviction.
When the Data Banks receive a properly completed dispute, notification
of the dispute is sent to all queriers who previously received the
report, and is included with the report when it is released to future
queriers.
A dispute becomes part of the specific report it is contesting.
If the report is changed by the reporting entity, the dispute notation
attached to the report is maintained until the subject elects to
remove it.
There are three possible outcomes for a dispute:
- The reporting entity corrects the report to the satisfaction
of the subject.
- The reporting entity voids the report.
- The reporting entity declines to change the report.
Secretarial Review
If the reporting entity declines to change the disputed report
or takes no action, the subject may request that the Secretary of
Health and Human Services (HHS) review the disputed report. A request
for Secretarial Review of a disputed report must be initiated through
the on-line Report Response Service. Please note that the dispute
and any accompanying documentation must be sent to the Data Banks,
not directly to the Secretary.
The subject also must:
- State clearly and briefly in writing which facts are in dispute
and what the subject believes are the facts.
- Submit documentation substantiating that the reporting entity’s
information is inaccurate. Documentation must directly relate
to the facts in dispute and substantially contribute to a determination
of the factual accuracy of the report. Documentation may not exceed
10 pages, including attachments and exhibits.
- Submit proof that the subject attempted to resolve the disagreement
with the reporting entity but was unsuccessful. Proof may be a
copy of the subject's correspondence to the reporting entity and
the entity's response, if any.
Secretarial Review Results
The Secretary will review disputed reports only for accuracy of
factual information and to ensure that the information was required
to be reported. The Secretary will not review the merits of a medical
malpractice claim in the case of a payment or the appropriateness
of, or basis for, an adverse action or judgment or conviction.
There are three possible outcomes for Secretarial Review of a dispute:
- The Secretary concludes that the report is accurate.
- The Secretary concludes that the report is inaccurate.
- The Secretary concludes that the issues in dispute are outside
the scope of Secretarial Review.
Improper Disputes and Requests for Secretarial Review
Filing a dispute is considered improper when the report in question
has been corrected or voided, or is already in dispute. If a subject
submits an improper dispute, the Data Banks will send notification
to the subject explaining why the report cannot be disputed.
A request for Secretarial Review is considered improper when the
report in question has not previously been disputed by the subject
practitioner, provider, or supplier. Before requesting Secretarial
Review, a subject must first attempt to resolve the disagreement
with the reporting entity and then may dispute the report according
to the instructions provided on the Notification of a Report in
the Data Bank(s) document. If an improper request for Secretarial
Review is submitted, the Data Banks will notify the subject that
the report must first be disputed.
For more information on disputes and statements, see the Fact
Sheet on the Dispute Process, the NPDB
Guidebook, and the HIPDB Guidebook.
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