Misleading Data

With regard to the article about the GAO report critical of the National Practitioner Data Bank (NPDB) in the January 19 issue, I would like to call your attention to what I believe is an additional kind of misuse of the data bank.

A colleague of mine challenged a managed care organization’s (MCO) denial for continued treatment. The MCO then canceled her membership on the provider panel and reported her to the NPDB for “failure to diagnose” and “failure to refer.” This is, of course, the language of “malpractice,” and the NPDB published the MCO’s report under the category for malpractice and incompetence—despite there having been no allegation of malpractice, no lawsuit, and no complaint of any kind by the patient.

My colleague was surprised to find that the NPDB has no process for verifying the accuracy or validity of such a report. With her appeals exhausted, the action stood, thereby allowing the MCO to act as accuser, judge, and jury for allegations of malpractice and incompetence.

My colleague is reluctant to pursue any further action due to fear of embarrassing the patient, who incidentally completed treatment to a successful outcome at the hands of this skillful and experienced therapist. Furthermore, with the apparent power of the MCOs and the current practices of the NPDB, it seems unlikely that it would be professionally rewarding to become the poster child for abusive MCO and NPDB actions.

I, however, would be interested in becoming involved in the general issue and would pose the following question: The report by the MCO to the NPDB was signed by a medical doctor, probably a psychiatrist, and I wonder whether an ethical investigation is in order for what I would call a fraudulent and misleading report. Please reply to me at [email protected].