A fundamental tenet of US jurisprudence is equal justice for all. The federal government oversees the National Practitioner Data Bank (NPDB). If a doctor’s carrier pays a settlement or judgment for a professional liability lawsuit, that is reportable to the NPDB. It doesn’t matter whether the payment is $1 or $10M. If you live in a state that is doctor-friendly, the likelihood of being a line item in the NPDB is lower than in states with more hostile medico-legal environments. If you are trying to figure out which of those states you live in, you can just compare professional liability premiums. That will deliver the answer. 

There are also differences between states in terms of whether withdrawal of an application for a medical license while under investigation will trigger a NPDB report. Yes, I know. Sounds esoteric.

The rule is this:

If you withdraw a new medical license application while under investigation by that Medical Board, it is NOT reportable.

If you withdraw a renewal medical license application while under investigation by that Medical Board, it IS reportable.

What might trigger an investigation? Well, a complaint to that state’s Board. Or discipline by another state Medical Board. Lots of things.

On the surface, it makes sense. If you are just getting started in a state, and preparing to work there, that state doesn’t really have jurisdiction over you. But, if you already have a track record in that state, the state might assert jurisdiction.

The simplest cases are where a physician has worked in a state for decades. He renews his medical license every year. A patient files a complaint. There is an ongoing investigation. The doctor then submits his renewal application while this investigation is ongoing; or just lets his license lapse – again while the investigation is ongoing.

That is reportable to the NPDB.

Now for a different scenario, that is not so intuitive.

A doctor had a medical license in state A decades ago. He let it lapse after he moved to state B. He has an active license in state B. Been that way for decades. A complaint is filed in state B, and this doctor is disciplined in state B. He then decides he’s had it with state B, and he wants out. He decides to submit an application for a medical license in state A.

On the surface, it seems like a new application. It seems like his old license in state A expired decades ago, right? Hold on.

State A will likely conduct an investigation based on what took place in state B.

If the doctor withdraws his application while the investigation is taking place, is it reportable to the NPDB? Is it considered a new or renewal application? Here, the doctor’s license lapsed decades ago.

Well, each state treats this differently.

In Massachusetts, for example, if an ancient license lapses and one wants to obtain what is ostensibly a “new license” years later, Massachusetts treats this as reviving a lapsed license.

If the Board has reason to believe the lapsed licensee has committed a violation of law or regulation or has deviated from good and acceptable standards of medical practice, the matter will be forwarded to the Enforcement Division. The Enforcement Division will review the lapsed license application and if necessary, investigate the matter as an open complaint. The Board may defer action on the lapsed licensee renewal pending completion of the investigation or 180 days after the Board’s receipt of a complete lapsed license application, whichever is shorter, or, should the Board issue a Statement of Allegations against the lapsed licensee, pending completion of the adjudicatory process by the Board. The 180-day period allowed for investigation shall be extended by any period of time during which the licensee is unavailable or fails to cooperate with the Board. (243 CMR: BOARD OF REGISTRATION IN MEDICINE).

Meaning, in Massachusetts, an old license can be “revived” as part of the application process for what the doctor believed was a new license application. If the application triggers an investigation, and the doctor then withdraws his application, that action will be reported to the NPDB as withdrawal of renewal license while under investigation.

In contrast, in Alaska, this revival of a lapsed license peters out at five years.

To apply for reinstatement of a license that has been lapsed for one to five years, an applicant must continue to qualify for a license and must submit:

1. 1. A completed application (this is the same form that is used to apply for an initial license)
   2. Payment of the license renewal fee
   3. Proof of meeting the continuing medical education requirements
   4. Clearance from the Federation of State Medical Board (FSMB) and Drug Enforcement Administration (DEA)
   5. Arrange for verification of licensure to be sent from each state where the applicant is or has been licensed as a physician
   6. Arranges for verification of hospital privileges to be sent from each hospital where the applicant has held privileges within the past five years.

A license that has been lapsed for five years or more is considered expired and may not be reinstated, an applicant must apply for a new license.

So, Alaska and Massachusetts would treat the original vignette differently. In both states, there may very well be an investigation. But in Alaska, because decades transpired between original licensure and application for the updated license, it would NOT be treated as a renewal application. If the doctor withdraws his application in Alaska while under investigation, decades after his original medical license lapsed, that act should not be reportable to the NPDB.

In contrast, in Massachusetts, the act of applying for an updated license will trigger revival, and be treated as a renewal application, even decades after the original medical license seemingly lapsed. If an investigation is initiated, withdrawal of THAT application, in Massachusetts, will trigger a NPDB report.

Confusing, right?

What’s the take-home message? Before withdrawing an application, consult with knowledgeable counsel on what’s at stake, if anything, with that action. If there’s an ongoing investigation while the application is withdrawn, the outcome may depend upon which state you are in, and your past history with that state.

What do you think?

Medical Justice provides free consultations to doctors facing medico-legal obstacles. We have solutions for doctor-patient conflicts, unwarranted demands for refunds, online defamation (patient review mischief), meritless litigation, and a gazillion other issues. If you are navigating a medico-legal obstacle, visit our booking page to schedule a free consultation – or use the tool shared below.

Jeffrey Segal, MD, JD

Chief Executive Officer and Founder

Dr. Jeffrey Segal, Chief Executive Officer and Founder of Medical Justice, is a board-certified neurosurgeon. Dr. Segal is a Fellow of the American College of Surgeons; the American College of Legal Medicine; and the American Association of Neurological Surgeons. He is also a member of the North American Spine Society. In the process of conceiving, funding, developing, and growing Medical Justice, Dr. Segal has established himself as one of the country’s leading authorities on medical malpractice issues, counterclaims, and internet-based assaults on reputation.

Dr. Segal was a practicing neurosurgeon for approximately ten years, during which time he also played an active role as a participant on various state-sanctioned medical review panels designed to decrease the incidence of meritless medical malpractice cases.

Dr. Segal holds a M.D. from Baylor College of Medicine, where he also completed a neurosurgical residency. Dr. Segal served as a Spinal Surgery Fellow at The University of South Florida Medical School. He is a member of Phi Beta Kappa as well as the AOA Medical Honor Society. Dr. Segal received his B.A. from the University of Texas and graduated with a J.D. from Concord Law School with highest honors.

In 2000, he co-founded and served as CEO of DarPharma, Inc, a biotechnology company in Chapel Hill, NC, focused on the discovery and development of first-of-class pharmaceuticals for neuropsychiatric disorders.

Dr. Segal is also a partner at Byrd Adatto, a national business and health care law firm. Byrd Adatto was selected as a Best Law Firm in the 2023 edition of the “Best Law Firms” list by U.S. News – Best Lawyers. With over 50 combined years of experience in serving doctors, dentists, and other providers, Byrd Adatto has a national pedigree to address most legal issues that arise in the business and practice of medicine.