Form 34 ReportingDiscrepancyLetter

DEPARTMENT OF HEALTH & HUMAN SERVICES

Health Resources and Services Administration

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Rockville, Maryland 20857

Bureau of Health Workforce

Name
Title
Entity Name
Address
City, State, Zip
RE: Potential National Practitioner Data Bank Reporting Discrepancy

To Whom It May Concern:

The Department of Health and Human Services, Health Resources and Services Administration,
Bureau of Health Workforce, Division of Practitioner Data Bank (DPDB), manages the National
Practitioner Data Bank (NPDB). DPDB is actively engaged in compliance activities that are
improving the completeness and accuracy of data reported to the Data Bank.
We have obtained data from [source] and compared it to [name of entity]’s reports to the NPDB
for [time period of review]. We believe there could be a potential discrepancy based on our
analysis of [source] and NPDB data. Specifically, [describe the potential discrepancy, such as
year(s) of review, number of claims submitted to outside source compared to number of reports
submitted to the NPDB].
Within 30 days from the date of this letter, please provide an explanation for what appears to be
a discrepancy in [entity’s] compliance with NPDB reporting requirements. If you assert that
[entity] has reported all required reports to the NPDB, please indicate so in your response.
Please contact [DPDB staff name, email, phone] should you have any questions. Thank you for your
attention to this request as your follow-through helps improve the completeness and accuracy of
NPDB data.

Sincerely,

Name
Title
Division of Practitioner Data Bank