THE DATA BANK
National Practitioners Databank
P.O. 10832 Chantilly, Va. 20153-0832
https://www.npdb.hrsa.gov/
https://www.npdb.hrsa.gov/enews/Jan2013enews.jsp
https://www.npdb.hrsa.gov/resources/glossary.jsp
Contact Information
Main 1-800-767-6732 AX 1-703-803-1964
San Clemente. Photo by Vivian Lowe
“Federal agencies, State law enforcement agencies, State Medicaid fraud control units, and State agencies administering or supervising the administration of a State health care program must report health care practitioners, providers, or suppliers excluded from participating in Federal or State health care programs. With respect to the reporting of exclusions by the specified State agencies, only the State agency that takes the action to exclude a health care practitioner, provider, or supplier is responsible for reporting that action to the National Practitioners Databank (NPDB).
The term “exclusion” means a temporary or permanent debarment of an individual or entity from participation in any Federal or State health-related program, such that items or services furnished by the individual or entity will not be reimbursed under any Federal or State health-related program. Federal health care programs and State health care programs are limited to those defined in the Social Security Act.
The Office of Inspector General (OIG) and other Federal agencies, State law enforcement agencies, State Medicaid fraud control units, and State agencies administering or supervising the administration of a State health care program also must report any revisions to previously reported exclusions, such as reinstatements, and whether an action is on appeal. For more information, go to Types of Reports in this chapter.
With respect to these types of actions, settlements in which no findings or admissions of liability have been made are statutorily excluded from being reported. However, exclusions that occur in conjunction with settlements in which no finding of liability has been made and that otherwise meet NPDB reporting requirements must be reported.” (NPDP Website)
“Any adverse action taken by the licensing or certification authority of the state as a result of a formal proceeding, including revocation or suspension of a license, reprimand, censure, or probation is reportable to NPDB. (78 FR 20473, Sec. 60.9)” (National Practitioner Databank)
The California Board of Registered Nursing (BRN) is mandated to report nurses who have come under the discipline of the Board, for reasons listed above, to The Office of Inspector General (OIG). A data report of this information is maintained by the National Practitioner Data Bank (NPDB).
When a nurse’s license is reinstated the Board also reports this information to the NPDB and it is kept on record.
By law, a nurse may lose the privilege to provide care to Medicare and MediCal patients. Consequences to the organization that employs the nurse are refusal of Medicare and MediCal reimbursement.
Even though a nurse’s license may be in good standing with the BRN, they may continue to be listed on the Medicare and MediCal Excluded Provider Lists.
It is the nurse’s responsibility to contact the appropriate Departments to have their name removed from the list.
Getting one’s name removed from the Medicare Exclusion list has proved to be a lengthy process requiring persistence and perseverance.
Web addresses, phone numbers, and office addresses of the list sites have been included on this site.
A self inquiry for the Medicare Exclusion List can be made at this site.
Office of Inspector General Exclusion List. U.S. Dept. of Health and Human Services
https://exclusions.oig.hhs.gov/
http://oig.hhs.gov/faqs/exclusions-faq.asp MEDICARE