QUESTION:         We recently rejected an application for initial appointment because the applicant misrepresented information on his application – he failed to disclose that he had been investigated at another hospital. We heard that there is a new National Practitioner Data Bank Guidebook and that it is more expansive in terms of what has to be reported. Do we have to report our decision to the National Practitioner Data Bank?

ANSWER:         You are correct. There is a new NPDB Guidebook that was published on April 6, 2015. You are also correct that the new NPDB Guidebook is more expansive in some areas (especially with respect to when an investigation starts). And, your question is a good one. In fact, there is a similar question in the new NPDB Guidebook. The answer in the new NPDB Guidebook to whether a falsification on an application is reportable is “it depends.” We can be more definitive than that. In our opinion, if you have the right bylaws language and follow the right process, you do not have to report a decision to reject an application because of a misrepresentation or omission.

The new NPDB Guidebook took the position that a hospital would have to report a clinical privilege decision based on the falsification of an application if the hospital determined that the falsification “could adversely affect the health or welfare of a patient.” We recommend that your medical staff bylaws or credentials policy (“bylaws”) clearly state that an application that contains a misstatement or omission is rejected and not processed. Thus, there should be no adverse professional review action, there should be no findings or conclusions that the physician’s professional conduct “adversely affects or could adversely affect the health or welfare of a patient,” and there should be no report to the National Practitioner Data Bank.

Importantly, a decision to reject and not process an application is an administrative decision not an adverse professional review action. The new NPDB Guidebook makes it very clear that “Administrative actions that do not involve a professional review action should not be reported to the NPDB.”

Your bylaws should also clearly state that a rejection of an application does not “entitle the applicant or member to a hearing or appeal.” To reinforce this point, the section of the bylaws that deals with hearings should also state: “None of the following actions constitute grounds for a hearing. These actions take effect without hearing or appeal…a determination that an application will not be processed due to a misstatement or omission.”