A health center’s immunity for reporting the revocation of a physician’s credentials to the National Practitioner Data Bank (NPDB) is not jeopardized by any potential false allegations that may have prompted the revocation, a federal court in Wisconsin ruled on Jan. 2, 2014.

In Sheikh v. Grant Regional Health Center, 3:11-cv-00001-wmc (E.D. Wis. Jan. 2, 2014), a health center reported its permanent revocation of a physician’s credentials to the NPDB—the national repository of information about credentialing and other actions involving healthcare providers—following termination of the physician’s employment with the health center. The NPDB report included the date of revocation, a timetable of the health center’s actions regarding the revocation, and a description that alleged that the revocation was prompted by “a series of instances of disruptive conduct and substandard and inadequate care.” Contending that these reasons were a front for other reasons for the revocation, the physician sued the health center on various state law grounds, most of which were premised on the NPDB report. The health center subsequently filed a motion for summary judgment, arguing that it was entitled to immunity under the Health Care Quality Improvement Act (HCQIA). That law (at 42 U.S.C. § 11111) gives any person or entity immunity to liability in any civil action regarding an NPDB report made “without knowledge of the falsity of the information contained in the report.”

“Importantly,” the court held in granting summary judgment for the health center, “the determination of whether the report was ‘false’ does not turn on whether the underlying merits of the reported action were properly determined.” Instead, falsity for immunity purposes turns on “whether the report itself accurately reflected the action taken.” Because the information in the NPDB report was consistent with what appeared in the minutes of the health center’s medical executive committee and in governing board documents, the court concluded that there was not sufficient evidence that the report was false or that the health center knew that the report was false.

As a caveat, the court noted that NPDB reporting immunity under HCQIA is limited to suits for money damages and that the physician’s desired relief was an injunction directing the NPDB to remove the physician’s report. The court, however, determined that it had “no authority to enter an injunction requiring a non-party government agency to remove [the health center’s] adverse action report from the [NPDB].” The physician’s “exclusive avenue” for such relief instead was a request for review of the report by the U.S. Department of Health and Human Services and administrative review of any resulting determination—neither of which the court could conclude the physician pursued based on the evidence.

While Sheikh offers a reminder of the broad scope of immunity for NPDB reporting and the importance accordingly for physicians to challenge the substance of allegations against them at the medical staff level, the court’s opinion is not without limitation.  As the court itself noted, the claims that it rejected on HCQIA immunity grounds were not based on the health center’s peer review process. Claims premised on a health care entity’s peer review process may be barred under another immunity section of HCQIA (at 42 U.S.C. § 11111), but only if the health care entity complies with certain due process protections during the peer review process.

In Sheikh, the court did not elaborate on the procedures that the health center followed before revoking the physician’s credentials. The lack of elaboration on this point leaves open the possibility that had the physician built his case around assertions of a deficient peer review process, he might have, with sufficient evidence, withstood a defense based on HCQIA peer review immunity.