1. Sloan, Andrea J. RN, Esq.

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Travel staffing nurses, by nature, work at a wide variety of healthcare facilities. How can you ensure that the individuals you're inviting into your facility are free from any license sanctions or criminal convictions? Two databases exist for researching adverse actions taken against nurses: the Healthcare Integrity and Protection Data Bank (HIPDB) and the National Practitioner Data Bank (NPDB).


Get hip with HIPDB

Under federal law, the HIPDB aims to protect the public against fraud and abuse in health insurance and in the delivery of health care. 1,2 HIPDB is a national data collection program for the reporting and disclosure of specific adverse actions taken against healthcare providers, suppliers, or practitioners.


The following types of information about these nurses will be reported to the data bank:


[white diamond suit]civil judgments against nurses in federal or state court related to healthcare delivery, such as court-ordered actions in lawsuits


[white diamond suit]federal or state criminal convictions against nurses related to healthcare delivery


[white diamond suit]actions by federal and state agencies responsible for licensing and certifying nurses


[white diamond suit]exclusion of nurses from participation in federal or state healthcare programs


[white diamond suit]any other adjudicated actions against nurses that may be established by regulations


[white diamond suit]all final, adverse actions. Information will be reported only when a finding or admission of liability exists.


When federal and state agencies, state licensing boards, and health plans conduct a review of a nurse, HIPDB alerts them of the nurse's past actions and qualifications. Those entities authorized to request data can use the data bank to make determinations about employment, contracting, certification, and licensure. Always consider information gleaned from the data bank alongside other relevant information. Aggregate data that don't identify any individual practitioner may be used for research or quality of care monitoring. The law specifically prohibits rerelease of data bank information, handing out fines of up to $11,000 for each breach of confidentiality violation.


Who has access?

Information in HIPDB is confidential and unavailable to the general public. However, federal and state agencies and health plans can request this information. Individual nurses or other practitioners can make inquiries concerning themselves for a fee of $10 per inquiry.


You may wonder, do all employers automatically check HIPDB on all nurses? The answer is no. First, inquiries to HIPDB aren't mandatory. Many employers won't spend the time or money to query HIPDB for every travel nurse they hire. But when the services of the practitioner are being billed to Medicare or Medicaid, the employer will query the NPDB, which contains information about practitioners excluded from Medicare/Medicaid participation. The employer can't bill for services provided by excluded practitioners.


Second, only employers authorized to make inquiries can obtain information from HIPDB. Determining whether you work for an eligible employer may be difficult. As previously mentioned, federal and state government agencies required to report information to HIPDB can also make inquiries. For example, if you work for the Department of Veterans Affairs, your employer may check the data bank. Likewise, if you work for a health plan, your employer may make inquiries to HIPDB. A health plan is defined, in part, as "a plan, program, or organization that provides health benefits, whether directly, through insurance, reimbursement, or otherwise."


If you make a self-query to HIPDB, you'll receive a report that includes a disclosure history of the names of any entities that have previously received the report. A self-query is the surest way to determine who has requested information about you and what information they received.


Other options

If you don't work for a federal or state agency, the NPDB is an option. Several critical differences distinguish the NPDB from the HIPDB. First, the NPDB primarily contains reports about physicians and dentists. Certain other licensed healthcare providers may be included, especially when they're credentialed or hold medical staff privileges.


The entities eligible for queries to the NPDB are also different from those of HIPDB. They include state licensing boards, professional societies (defined as those that engage in formal healthcare peer review), hospitals, and certain other healthcare groups that engage in peer review. The general public can't make inquiries. Plaintiffs' attorneys can make queries, but only if they can show that a hospital failed to make a mandatory query. Individual practitioners have the ability to self-query.


Although HIPDB inquiries are optional, NPDB queries are mandatory for hospitals when a practitioner applies for medical staff privileges and, subsequently, every 2 years, as part of the ongoing credentialing process. The information reported to the NPDB is also significantly different. Medical malpractice payments-regardless of the amount-are reportable and must be reported by anyone who pays the fine, including an insurance company or the healthcare provider. Adverse licensure actions, actions taken against a practitioner's clinical privileges, and professional society membership actions are reportable.


In March 1997, Health Care Financing Administration (renamed Centers for Medicare and Medicaid Services) sanctions joined the list of reportable actions. Practitioners who've been declared ineligible from participation in Medicare or certain state healthcare plans under the Social Security Act are reportable. The NPDB contains reports retroactive to February 1981 on such exclusions. It has confidentiality provisions prohibiting redisclosure and provisions for fines for violations.


Although these two searchable databases aren't without restrictions, they're a way to protect your nursing staff. The HIPDB and NPDB are useful tools for ensuring that the travel nurses, as well as any newly hired nurses, that join your staff are free from convictions and sanctions.


Still unsure?

Several excellent sources of information contain additional details about HIPDB and NPDB.


1. NPDB-HIPDB Help Line: 1-800-767-6732, 8:30 a.m. to 6:00 p.m., EST, Monday through Friday, except holidays.


2. NPDB-HIPDB Web site:


3. National Council of State Boards of Nursing Web site:


4. State Boards of Nursing Web site:





1. The Health Insurance Portability and Accountability Act of 1996, Section 221(a), Public Law 104-191. [Context Link]


2. Balanced Budget Act of 1997, Public Law 105-33, [S]1128E of the Social Security Act. [Context Link]