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Appendix E: US Data Bank details<br />
The following table provides an overview of the National Practitioner Data Bank and Healthcare Integrity and Protection Data Bank in the US (see Chapter 7).<br />
Database National Practitioner Data Bank Healthcare Integrity and Protection Data Bank<br />
Purpose NPDB is an information clearing house to collect and release all licensure<br />
actions taken against all health care practitioners and health care entities,<br />
as well as any negative actions or findings taken against health care<br />
practitioners or organizations by Peer Review Organizations and Private<br />
Accreditation Organizations.<br />
HIPDB was implemented to combat fraud and abuse in health<br />
insurance and health care delivery and to promote quality care.<br />
HIPDB alerts users that a more comprehensive review of past<br />
actions by a practitioner, provider or supplier may be prudent.<br />
Reporting<br />
Organizations<br />
Information<br />
Available<br />
Medical malpractice payers<br />
State health care practitioner licensing and certification authorities<br />
(including medical and dental boards)<br />
Hospitals<br />
Other health care entities with formal peer review (HMOs, group<br />
practices, managed care organizations)<br />
Professional societies with formal peer review<br />
State entity licensing and certification authorities<br />
Peer review organizations<br />
Private accreditation organizations<br />
Medical malpractice payments (all health care practitioners)<br />
Any adverse licensure actions (all practitioners or entities)<br />
Revocation, reprimand, censure, suspension, probation<br />
Any dismissal or closure of the proceedings by reason of the<br />
practitioner or entity surrendering the license or leaving the State<br />
or jurisdiction<br />
Any other loss of license<br />
Adverse clinical privileging actions<br />
Adverse professional society membership actions<br />
Any negative action or finding by a State licensing or certification<br />
authority<br />
Peer review organization negative actions or finding against a health<br />
care practitioner or entity<br />
Private accreditation organization negative actions or findings against<br />
a health care practitioner or entity<br />
Federal and State Government agencies<br />
Health plans<br />
Licensing and certification actions<br />
Revocation, suspension, censure, reprimand, probation<br />
Any other loss of license - or right to apply for or renew - a<br />
license of the provider, supplier, or practitioner, whether by<br />
voluntary surrender, non-renewal, or otherwise<br />
Any negative action or finding by a Federal or State licensing<br />
and certification agency that is publicly available information<br />
Civil judgments (health care-related)<br />
Criminal convictions (health care-related)<br />
Exclusions from Federal or State health care programs<br />
Other adjudicated actions or decisions (formal or official actions,<br />
availability of due process mechanism and based on acts or<br />
omissions that affect or could affect the payment, provision, or<br />
delivery of a health care item or service)<br />
Ministry of Health 95<br />
Provincial Review of Physician Licensing, Credentialing, Privileging & <strong>Performance</strong> Management<br />
© 2012 KPMG LLP, a Canadian limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative<br />
(“KPMG International”), a Swiss entity. All rights reserved.
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