The Healthcare Integrity and Protection Data Bank

The Healthcare Integrity and Protection Data Bank

The Healthcare Integrity and Protection Data Bank

The U.S. Department of Health and Human Services has determined that annual losses arising from healthcare fraud range from 3 to 10 percent of all healthcare expenditures–between $30 billion and $100 billion based on estimated 1997 expenditures.


The Healthcare Integrity and Protection Data Bank (HIPDB) was created in an attempt to combat healthcare fraud. An offshoot of the Health Insurance Portability and Accountability Act of 1996, HIPDB identifies activity by healthcare providers, practitioners, and suppliers that may require investigation.

One of the pieces of data that HIPDB collects is information concerning final adverse actions that have been taken against healthcare providers, suppliers, or practitioners. Such information may or may not be indicative of fraudulent healthcare activity. Final adverse actions do not include settlements made with providers, practitioners, and suppliers in which no findings of liability have been made. They also do not include any actions taken with regard to malpractice claims.


The HIPDB requires government agencies and health plans to report:


  • Civil judgments against a healthcare provider, a supplier, or a practitioner in federal or state court related to the delivery of a healthcare item or service.
  • Federal or state criminal convictions related to the delivery of a healthcare item or service.
  • Actions by federal or state agencies responsible for the licensing and certification of healthcare providers, suppliers, and licensed healthcare practitioners, including formal or official actions, such as revocation or suspension of a license (and the length of any such suspension), reprimand, censure or probation, any other loss of license; any other negative action or finding by such federal or state agency that is publicly available information; exclusion from participation in federal or state healthcare programs; and any other adjudicated actions or decisions that the Secretary of Health and Human Services shall establish by regulation.

What the Final Adverse Action Reports Must Contain

Reports of a final adverse action against a healthcare provider, practitioner, or supplier must include the following information:


  • The name and tax identification number of the healthcare provider, supplier, or practitioner who is the subject of the action.
  • The name (if known) of any healthcare entity with which the healthcare provider, supplier, or practitioner is affiliated or associated.
  • The nature of the final adverse action and whether the healthcare provider, supplier, or practitioner has appealed the action.
  • A description of the acts or omissions and injuries upon which the final adverse action was based and such other information as the Secretary of Health and Human Services determines is required for the appropriate interpretation of the reported information.

Information concerning a final adverse action, which is reported under the HIPDB, can be disclosed, upon request, to the healthcare provider, supplier, or licensed practitioner who is the subject of the action. They can then dispute the accuracy of the information.


Access to the information contained in the HIPDB is available to federal and state governmental agencies and health plans. By law, HIPDB information concerning specific practitioners, providers, or suppliers can not be disclosed to members of the general public. However, persons or entities may request the disclosure of HIPDB information that does not identify any particular healthcare provider, licensed practitioner, supplier, or entity.

Copyright 2011 LexisNexis, a division of Reed Elsevier Inc.

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