New database to include sanctioned physicians

It’s official: Despite the protests of numerous physician groups, the Office of the Inspector General has gotten its way with the new Healthcare Integrity and Protection Data Bank (HIPDB): the database will register all so-called adverse actions taken against physicians and other providers — even if those actions are still under appeal.

The HIPDB, mandated by the Healthcare Insurance Portability and Accountability Act (HIPAA), is intended to be a register of any adverse actions against providers, including civil or criminal judgments or convictions, licensing actions, and exclusions. It will include actions that involve unsound fiscal, business, or medical practices that cost Medicare money, don’t meet accepted standards of care or affect patient care.

The problem, critics say, is that the "final adverse actions" the database is supposed to contain aren’t really final at all. Cases under appeal can still be included in the database. "We remain opposed to the ruling in its final form on that point," say Pat Smith, director of governmental relations for the Englewood, CO-based Medical Group Management Association. "Every provider group’s concern here is that the information [in the database] is accurate and that it doesn’t go in until there is some kind of final adjudication."

In addition to physicians, the database will also include records on dentists, nurses, pharmacists, and all other health care practitioners who are licensed or authorized at the state level. It also includes health care suppliers who furnish or provide access to health care services or supplies. These include durable medical equipment companies, pharmaceutical companies, medical record services and billing companies.

If you’re thinking it might be interesting to see what your colleagues or providers you work with have been up to, forget about it. The database is primarily for federal and state government agencies, but health plans can take a peek, too, to help them size up existing or potential physician partners. And anyone included in the database is allowed to review what it says about them.

OIG says it will routinely mail copies of any report filed in HIPDB to the subject, who is allowed to contest the accuracy of the information. If you don’t receive a copy, you’re allowed to submit a "Request for Information Disclosure" to: Tony Marziani, director, Information Systems and Investigative Support Staff, Office of Investigations, OIG, Room 5046, Cohen Building, 330 Independence Avenue, SW, Washington, DC 20201; or call (202) 205-5200.

OIG cautions, however, that submitting a request under false pretenses is a criminal offense, subject to a minimum fine of $5,000.