Sham Peer Review

09/09/2025

The National Practitioner Data Bank ( NPDB)
By: Richard B. Willner

The National Practitioner Data Bank (NPDB) is a 20 year experiment created by an act of Congress along with the Health Care Quality Improvement Act of 1986 ( HCQIA). The experiment has failed. It is time to abolish this agency.

The NPDB is a black list reminiscent of the McCarthy blacklist of the 50s. Instead of targeting the Red Menace, or Communists, the target of this blacklist of the White Menace: “Bad Doctors.”

The problem is that too many good doctors’ names are submitted to this list. And it is disturbingly easy to do.

The perception is, if a doctor is included on this list, they must be a bad doctor, otherwise, why are they on the list?

The consequences of a listing are dire. As a result of a listing in this “data bank”, many doctors become unemployed and unemployable. For surgeons who must use a hospital Operating Room, the “data bank” is a permanent as a tattoo.

Clearly, a doctor has a “liberty interest” in his professional career and reputation. Also, plenty of hard work goes into becoming a doctor. A listing by this agency irreparably damages a doctor’s career and his reputation. A listing thus leads to a loss of liberty. Yet in the United States of America, we have this document called the Constitution. So, in examining the National Practitioner Data Bank, are doctors being deprived of liberty without due process of law?

When Congress created the NPDB, they created a highly unique agency. This is the only federal agency that has delegated publication power to corporations, corporations that have been granted the authority to publish whatever they please on federal stationary.

Not only does the federal government allow them to publish, they assist them with the distribution of the publication, and they also grant them immunity for what they publish. These publishers, private corporations, have thus been released from the confines of laws of libel. They can publish whatever they please without fear of reprisal and the federal government protects them behind a veil of immunity. This means that the victims of defamation by said corporations have no recourse against those corporations for various and sundry torts such as defamation.

Consider the scenario where an entry is made to the NPDB that is simply flat out defamation. I estimate that the entire process takes less than one hour. What recourse does the doctor have to combat this? In the real world, in the event of defamation, the doctor could sue for defamation to recover any resulting damages. When a defamatory statement is laundered thru the NPDB, there is no recourse. Any lawsuits will be dismissed under the veil of immunity defense. The doctor can then proceed with a time consuming and arduous formal “secretarial review” to obtain redress. That is assuming he, or his lawyer, has heard of this. Chances are, he has not. One doctor fought a defamatory listing for eight years before someone informed him of the secretarial review option. He had never heard of it. No lawyer advised him of it.

And the “secretarial review” option is not a de novo review of the facts of the case. The NPDB does not do that. In fact, no agency does. The chances of prevailing are remote. The NPDB is designed as the “roach motel” of medicine. Statements can be entered freely and rarely come out.

In addition to release of liability for defamation. Congress also released these private corporations from fear of an antitrust suit. But it is only reasonable that by granting such immunity, the federal government must assume responsibility for the wrongful action of these private corporations, let the victims of a wrongful publication be denied the equal protection of the law. And isn’t such protection also part of our Constitution?

Upon submission, these corporate publications are distributed on federal letterhead. There is no scrutiny by the federal government to verify the accuracy of these corporate publications. There is no oversight. They publish and thus endorse what is mailed to them in a government publication originated from Washington DC.

The publications are distributed widely. First, they are sent to the doctor’s employer, his licensing board, any secondary licensing agency, their certification board and every hospital he works at, or will work at in the future. The item is then sent to the DEA, the agency that issues the prescription powers.

With each publication, the doctor is inevitably subjected to a new “adverse action” which generations secondary “adverse action reports”. Other states he is licensed in will issue their own investigation and still another Data Bank. This is the multiplier effect, where one entry becomes 5 entries. Clearly there is a double jeopardy issue here.

And then there is a due process issue. If a hospital is publishing so called “data”, how exactly was such “data” arrived at? The reference to a data bank entry as “data” would suggest some sort of mathematical accuracy to the publication. Yet who guarantees it’s accuracy? Does false information become data upon typing it into a computerized “data bank”? When it comes to computer data entry, garbage in equals garbage out.

There are very serious consequences to a data bank entry. If the doctor loses his job, he loses his liberty. Is there any guarantee this loss of liberty if accompanied by the requisite “due process of law” that is guaranteed by the US Constitution? The answer to this question is a resounding no.. Congress did not mandate these hospitals comply with Constitutional due process standards before they submit what amounts to corporate verdicts of corporate trials. As such a trial, no appeal is allowed, no discovery is allowed and no confrontation is mandated.

Congress can only do what they are authorized to do . All congressional authority comes from the Constitution. The Constitution guarantees the right to constitutional due process before a man is deprived of his liberty. A listing leads to a loss of liberty, yet there is no guarantee of due process.

And that is where Congress failed. They failed to abide by the supreme law of the land. Congress created an agency that is in fundamental violation of the rules they are obligated to follow. Thus the NPDB must fail, as the McCarthy blacklist failed, lest we all lose more good doctors. That that is bad for all of us.

For further information on the Data Bank, please feel free to consult with The Center For Peer Review Justice at info@PeerReviewjustice.org or 504-621-1670

08/27/2025

Richard B. Willner received the Civic Leader Award from the Alliance for Good Government. Richard has enclosed his speech below:

"First of all, I would like to sincerely THANK the committee which granted me this enormous honor. You cannot know how much I appreciate it. Second, I would imagine many of you today are wondering who I am and why I am here. I stand among enormously talented people, in this room who have given far more to their community and our Parish, than they have taken.

I operated an emergency 24 hour hot line for physicians who are depressed and considering killing themselves. Unfortunately, and it may come as a surprise to you, a LOT of doctors commit su***de every year. I won’t burden you with the numbers, because as you realize… each one is a tremendous loss to our society.

I have been in a position to hear about many very sad events in the lives of doctors. Most of those occur among decent, hardworking people who have been improperly and unfairly INVESTIGATED and maligned by various committees and practice boards. Some have lost their licenses completely. Of course we acknowledge that some doctors need to be disciplined. Unfortunately, this process can also be perverted for financial reasons against competitors. I see it all the time.

You need to know that doctors give up their youth almost completely to become doctors. While their college friends were exploring Europe with a backpack, your doctor was slaving at 9 hour labs trying to make a few grains of aspirin. So, when a doctor sees his/her medical license under threat, it is so deep a loss as to be almost unimaginable.

I have had the honor to help doctors get their licenses back and stop unfair practices against them, even though I am not an attorney. It is a peculiar skill that I have. I know that a number of you are in authority positions and as part of your work, you create regulations.

Our society needs regulations in order to survive. I get that. But, I beg you, when it comes to making more regulations for doctors….please think twice. They have enough regulations/practice boards/hospital boards/pharmacy boards who watch them every day. Enough is enough.
I again express my deep appreciation for this honor and I wish you all GOOD health and GOOD luck!"

Richard B. Willner
The Center for Peer Review Justice

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08/26/2025

Sham Peer Review --Due Process Rights
By: Richard B Willner, Center for Peer Review Justice

Medical peer review is the process by which a committee of physicians investigates the medical care rendered by a colleague in order to determine whether accepted standards of care have been met. The professional or personal conduct of a physician may also be investigated. If the committee finds that the physician departed from accepted standards, it may recommend limiting or terminating the physician’s privileges at that institution. If the physician’s privileges are restricted for more than 30 days, federal law requires the peer review committee to report that fact to the National Practitioner Data Bank.

There is no federal statute that requires peer review committees to observe due process, which the Supreme Court has defined as (1) giving written notice of the actions contemplated, (2) convening a hearing, (3) allowing both sides to present evidence at the hearing, and (4) having an independent adjudicator (2). Prior to the Health Care Quality Improvement Act of 1986 (HCQIA) (3), the effects of an adverse peer review finding were restricted to the hospital involved. Because the HCQIA mandates the reporting of disciplinary actions of peer review committees to the National Practitioner Data Bank, such a report could harm a physician’s career throughout the nation.

Medical peer review is usually based on the screening of medical records, which places physicians with poor record-keeping skills at a disadvantage, and ignores the fact that medical records are often a poor indicator of the quality of care (5). Additionally, there is no requirement that the physician be given notice and an opportunity to be heard, and there is no requirement that members of the peer review committee be unbiased. The HCQIA recommends that the physician should get notice of the allegations, time to prepare for a hearing, a list of witnesses, the right to legal counsel, and an impartial fact finder. However, the act concludes “A professional review body’s failure to meet the conditions described in this subsection shall not, in itself, constitute failure to meet the standards of this act).” This failure of the HCQIA to require due process calls into question the fundamental fairness of the medical peer review system.

The reason that due process should be a part of any fact-finding endeavor was stated by Justice Goldberg in SILVER v NEW YORK STOCK EXCHANGE:

‘Experience teaches…that the affording of procedural safeguards, which by their nature serve to illuminate the underlying facts, in itself often operates to prevent erroneous decisions on the merits from occurring .’


The purpose of requiring due process is to ensure that the actions taken are not arbitrary, capricious, or unreasonable. Where there is no due process, the system invites abuse.

Peer review in its current form fails to protect an investigated physician from committee members having an economic or personal bias. Economic bias occurs when a committee member has a financial interest in the outcome. If the challenged physician is a partner or associate, any error that he may have made is likely to be considered to have been unavoidable. On the other hand, peer review has already been used to force a competing physician out of practice. Such economic bias denies due process . The United States Supreme Court struck down a decision from Ohio’s municipal court system in which the judge was partly paid from the fines he assessed. The Court found that the system gave an incentive to rule one way rather than the other.

Personal bias is inevitable when coworkers judge each other. Some people are very likable, and others illuminate the room by their absence.

Federal law prohibits a federal judge from hearing cases in which his impartiality might reasonably be questioned or in which he has a financial interest . The same standards should apply to member of a peer review committee. The potential for abuse when these suggested procedures are not followed would indicate the need for mandatory due process.
Due process, which is designed to limit these abuses, is not required by the Constitution of the United States unless there is government action that affects a liberty or property right. The case of PAUL v DAVIS illustrates the legal meaning of property rights as applied to employment. The police labeled the plaintiff as a shoplifter and advised local businesses to watch him carefully. The plaintiff sued, claiming that the government was injuring his reputation without due process. The Supreme Court ruled against the plaintiff, but stated that should there be an effect on employment, then such injury would invoke the constitutional protection .

The sole reason for reporting the results of peer reviews is to restrict the practices of incompetent physicians. Congress cited the following as the very reason for the act: ‘There is a national need to restrict the ability of incompetent physicians to move from state to state without disclosure or discovery of the physicians’. incompetent performance .’

The right to practice medicine without a governmental agency erroneously reporting that a physician has been deficient in his actions is a constitutional property right. Rights, even constitutional rights, can be waived by express agreement, or by the failure to assert those rights. State institutions, however, may not make waiver of a constitutional right a condition for employment .

In 1986, New York State enacted a system of physician discipline that includes a hearing presided over by an administrative law judge, to ensure due process. Although this system provides due process, it has the glaring problem of giving control of hospital privileges to lawyers. A far better solution is for peer review committees to be required to observe due process. Lawyers and other non-physicians may have a role as consultants, but should not be voting committee members.

The effects of an adverse peer review decision are no longer limited to the relationship between a physician and a hospital. The decision becomes part of the National Practitioner Data Bank. Medical peer review must provide physicians the protections of due process.

Tags: HCQIA, National Practitioner Data Bank, NPDB

02/28/2025

09/02/2023

www.peerReviewJustice.org Sham Peer Review
When something just does not feel right.

Get help fast.

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06/28/2023

From The Center for Peer Review Justice
www.PeerReviewJustice.org

Senator Milkovich on Hearing on SB 187: Licensees' Bill of Rights. By Senator John Milkovich.

Senator Milkovich: "Over the last decade, Licensing Boards have leveled false accusations against professionals, extorted exorbitant fines, rigged administrative proceedings, misused Board proceedings to destroy competitors, and engaged in patent conflicts of interest.

Senate Bill 187, by State Senator John Milkovich, seeks to ensure Due Process for Louisiana's professional licensees in licensure and disciplinary proceedings–– and seeks to curb abuses by Licensing Boards. Senate Bill 187 will be heard by the Senate Commerce Committee on Wednesday, May 1st, at 9:30 a.m. in the State Capitol. Licencees are encouraged to attend and make their voices heard. Persons who wish to testify, or have questions, should call 318-425-1957.

Senator Milkovich: "Licensing Boards in Louisiana have perpetrated a series of abuses against professional licensees: the fabrication of complaints and evidence; the exploitation of Board powers by Board Members to destroy professional competitors; coercing physicians who use neither drugs nor alcohol into drug rehab; the refusal to disclose to licensees copies of their case files; anonymous complaints; the denial of an explanation to licensees of the charges against them; a racket in which a disciplinary officer files false charges against professionals and then refers the professionals to her boyfriend, a lawyer, who collects a large fee; shakedowns for large fees that professionals are forced to pay, in order to practice their profession; rigged proceedings; and the Board's practice of functioning as judge, jury and prosecutor.

Notes Senator Milkovich, "Professionals, small business owners, and technical specialists spend their entire careers learning their skills and mastering their professions. Louisiana Physicians, who are among the groups targeted by abusive Boards, are among the most thoroughly educated, highly skilled and selfless professionals in the world–– and are some of the best physicians in America. Our doctors work long hours, fight with the HMOs and ERISSA plans to get paid, and grapple with endless red tape imposed by state and federal agencies. We owe them gratitude-- not grief.”

Continues Milkovich, "Doctors, Dentists and all other licensed professionals in Louisiana are entitled to just and transparent proceedings. None of them deserve to have their careers destroyed by corrupt practices or rigged proceedings. We understand that there must be a sound disciplinary process to protect the public. However, the goal of Board proceedings for licensees should be impartiality, fairness and integrity-- not intimidation, falsification, and inequity."

Senator Milkovich said, Under SB 187, professional licensees would be entitled to a clear statement of the charges against them; the identity of the accuser; a fair investigation; an independent judge; the prohibition of secret communications between the Investigator and the Board; receipt of their complete file; a fair hearing; full discovery; legal counsel; and meaningful judicial review.

Concludes Milkovich, "Licensing Boards exercise governmental power over professionals. However, there are few checks and balances on their power. Some Boards are out of control, run rough-shod over professionals, and abuse their power. It is time to require that Boards respect the Rule of Law; obey the Constitution; and treat licensees fairly.
--
John Milkovich
Louisiana Senate
656 Jordan Street
Shreveport, LA 71101
(318) 425-1957
johnmilkovichforsenate@gmail.com

06/15/2023

DOES THE GOVERNMENT KNOW WHAT IT IS DOING TO PHYSICIANS?
Don R. Read, MD, Past President TMA

Physicians spend almost twice as much time each day typing on computers and filling out paperwork as they do seeing patients. That astonishing conclusion comes from research published this week in the Annals of Internal Medicine.

Just think about that. How would you feel if you spent two hours documenting every hour of work that you do? How would your boss feel about it? You’d be depressed and frustrated; your boss would probably be angry as hell.

Patients should be up in arms over this report. Taxpayers should be up in arms. Physicians already are up in arms because we already knew this was true — and we know it’s just going to get worse.

We know it’s going to get worse because we know what’s causing it in the first place.

And that’s what’s missing in this study. Why? Why do physicians spend just 27 percent of their time “on direct clinical face time with patients” and 49.2 percent on electronic health records (EHRs) and “desk work”? From my nearly 50 years in medicine and thousands of conversations I’ve had with my colleagues, I can guarantee you it’s not a willing choice.

But again, the question is “why.” Why is this happening? Part of it has to do with EHR systems that appear to have been designed by someone who never set foot in a physician’s exam room. They’re clunky, not intuitive, and don’t fit the flow of how we examine, diagnose, and interact with our patients.

But the bigger issue is why we have to enter all of this data into a computer system in the first place. It comes back to an alphabet soup of government regulations that definitely were written by someone who’s never been in the exam room with a patient. The Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-Based Payment Modifier (VBM) program all aim to “capture” the quality of care we’re providing and score us on the cost of that care. MU — the worst-named government program ever — actually cuts our Medicare payments if we don’t use an EHR.

A study published in Health Affairs earlier this year estimates the cost in physician time to comply with just one of those programs, PQRS, exceeds $50,000 per primary care physician per year. That’s a lot of money; but it’s also a lot of our time. That’s time the government has stolen from our patients.

And — as I mentioned earlier — it’s only going to get worse. The Merit-Based Incentive Payment System (MIPS), part of the Medicare Access and CHIP Reauthorization Act (MACRA), begins in January. MIPS is supposed to replace PQRS, MU, and VBM. But, as I wrote in this space in June, the new program looks to be far more costly, complex, and confusing than the costly, complex, and confusing programs it is replacing.

The Centers for Medicare & Medicaid Services (CMS) estimates MACRA will add $128 million a year in compliance costs above the costs of complying with the programs it is replacing. Texas Medical Association analysis finds that “official” number woefully low.

And all of that brings us to one more, even bigger question: Does the government know what it’s doing to physicians?

We went to medical school and dedicated our lives to helping people heal and stay healthy, not to become data entry operators. But that’s what we have become, and that’s taking a toll on physicians, our patients, and the entire health care system. Physicians are burned out and unhappy, patients have less time with their doctors, and everyone has to pay more to get less care.

I’ve been a patient — a seriously ill patient — and I owe my life to the physicians who helped me recover from West Nile virus encephalitis. Like every patient, I don’t want a burned-out, unhappy doctor who’s enslaved by his computer. I want a bright-eyed, engaged, and satisfied physician who has the time and energy to put me — and my health — first.

More articles at The Center for Peer Review Justice
www.PeerReviewJustice.org
Legal@peerReview.org
The Sham Peer Review Hotline: 504-621-1670

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05/28/2023

HOW TO DESTROY YOUR COMPETITOR
(OR SOMEONE YOU DO NOT LIKE)
WITH MEDICAL PEER REVIEW

Bring the peer review action in the following ways:

1. Cut the physician's support staff. This generates inefficiency and disharmony in the remaining staff. It also lays the basis for the following.

2. Place a 'mole' in the office staff to collect a list of alleged wrongdoing, including the most trivial rumors and innuendoes. It is not the validity of these allegations, but the volume of the list, which matters. The target physician will be unable to address all the items if it is long, and the community will be more likely to believe it. It is preferable to use an outsider, newly hired, as the mole. Once the target physician is gone, fire the mole.

3. Include the Chief of Staff and two other adversarial physicians in the scheme. They can actually be kept ignorant of the true motives behind the attack. All physicians are busy and might accept data from authoritative figures, without carefully confirming their validity. Tell these doctors, for example, that the target has serious problems, which cannot be revealed without "hurting" him or her, implying personal failings, which must be kept confidential.

Hospitals which have this process well greased will usually have the same doctors "elected " to key positions year after year. They will maintain a clique of insiders who can be relied on to be supportive.

4. Begin a rumor campaign. Leak allegations to the entire medical staff and community at large. This can be done very cryptically. Any secretary who must type up corporate documents may unwittingly serve the purpose.

5. Restrict the physician's access to records. This will hamper efficiency and prevent proof of competency.

6. Use the most severe punishment (especially summary suspension) at the very outset of the review process. This will emotionally damage the target physician and his/her family, creating a shock effect. It also promotes the community's doubts about the physician's competence and character. This trauma may be all it takes to scare the physician out of town. A hasty departure only further damages the target's credibility, so that he/she will be presumed guilty. The immunity provided by the 1986 law prevents any scrutiny of the decision.

7. Limit the target physician's access to allegations, and keep them as vague as possible. The broader and more nebulous the charge, the harder it is to address it. Make the list as long as possible, even adding half-truths, frivolous allegations, rumors, and outright lies. The target will hardly have time even to read the list, and might succumb without a fight. The sheer length and vagueness of the list assures failure of the target to refute all the charges.

One added advantage to a massive list is that any physician asked to review the cases will also be overwhelmed and be more likely to accept the hospital's version of the cases.

8. Prevent the target from obtaining privileges at other institutions. Then, spread rumors dto the staff about the rejections by other institutions. This maneuver also keeps the target broken financially, unable to sustain legal aid.

9. Set up hearings so that only a few key insiders know what is happening. By this point, the whole hospital staff may have ostracized the target physician, if the rumors are sufficiently scandalous.

10. To help implement the plan, hire an aggressive law firm that favors corporate interests. Hospitals that routinely practice these schemes seem to use the same law firm.

11. Break the physician financially. Keep the list of allegations and the list of witnesses as long as possible. This will prolong the legal nightmare for the target, producing massive legal fees. The hospital can easily outlast the targeted physician in a protracted legal battle.
Clearly such dealings are not isolated incidents. It may well be that this systematic attack on individual physicians is being formulated by law firms that cater to aggressive hospitals, particularly those hospitals with monopolistic aims. The hospital's success in such attacks is almost guaranteed by the new federal law. Even when the hospital committee flagrantly denies due process to the physician, there is no longer a mechanism for exposing such practices. The 1986 law provides a degree of immunity that effectively veils their proceedings. Our best initial recourse is public awareness. If you have had a similar experience, or any insights into hospital-privilege battles, THE CENTER FOR PEER REVIEW JUSTICE, http://www.PeerReviewJustice.org would like to hear from you.

05/05/2023

SHAM PEER REVIEW

Description of disease:

The scientific method generally involves collecting data, making observations, developing theories on the basis of those observations, performing tests of those theories under controlled circumstances, and finally, taking a course of action if those tests prove the theories. Sham peer review is a backward malignant bastardization of the scientific method. It involves making a decision to take the action, then asking minions to collect the data to support the arbitrary decision. It happens in the corporate world every day, i.e., an executive wants to fire an employee, so he asks his lackeys to "get the documentation". This is exactly what happens to physicians in sham peer review as well.

Peer review is a healthy, scientific, positive process by which physicians review what their peers are doing, looking at variances, and studying the how simple outcomes of these variances, and then making recommendations based on these studies. If Dr. X does things differently from Dr. Y and Dr. Z, let's look at Dr. X's outcomes, and if they are not as good as Dr. Y's or Dr. Z's outcomes, perhaps Dr. X might consider changing his methods in order to improve patient care. The course of action usually involves additional education, and punitive actions really have no role in this type of process.

Sham peer review however is not at all concerned with improving patient care, it is usually motivated by corporate profits, greed, or sometimes merely as a personal vendetta if there has been a long-standing or intense animosity towards the physician. It is intended to get a physician "out of the way", perhaps kicked off of a medical staff, or even imprisoned, because he stands in the way of corporate profits even, or especially, if he is a whistleblower on the corporation's illegal or dangerous actions, although the physician may be acting out of a genuine concern for patient safety and care.

Prevalence:

Sham peer review is routinely used by hospital corporations and is currently at epidemic proportions. We know of many outstanding, good, ethical physicians who are currently no longer practicing his profession and support their families. Corporations use lawyers, the physician's personal enemies and economic competitors, and even legislators and law enforcement officials to help them in this bastardization of the peer review process. Sham peer reviewers are often successful if their financial resources dwarf the monetary resources of the physician they are trying to destroy. One of the main difficulties which the sham peer reviewer faces is keeping his true motives hidden, so the corporations which have slick public relations departments and are skilled at press releases, are often the most effective.

Diagnosis:

A good general rule is, any charges against a physicians methods which are not the result of medical staff committees staffed by physicians acting in accordance with medical staff bylaws, is strong suspicion for "SHAM" peer review. Truth often has no meaning in the sham peer review campaign, only the amount of efficient "spin" which the sham peer reviewer can generate, much in the same way that a lawyer is not interested in the truth when he is defending a known murderer, or a prosecuting attorney is interested in the truth because he simply wants to win his case also. Evidence which interferes with winning cases, even if it is truth, is generally disregarded or hidden. It is very common that the physician targeted for Bad Faith Peer Review has no history of medical malpractice suits or complaints to the State Medical Board.

Treatment:

An effective treatment is to consult with the Center for Peer Review Justice. We invite your email at info@PeerReview.org or a call on the Sham Peer Review Hotline: 504-621-1670