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Hospitals are intentionally shirking their duty to identify and report incompetent medical practitioners, and it is causing catastrophic injuries to patients. Why are hospitals doing this? Two decades of health care reforms have changed the way physicians and hospitals interact in the U.S. health care system, and as a result, the traditional health care oversight tools no longer work to ensure physician competence. With three out of four physicians now employees of hospitals or health care systems, hospitals have become the guardians of both the internal and external warning systems designed to flag incompetent practitioners. As the guardians, hospitals are required to report incompetent practitioners to the National Practitioner Data Bank (NPDB), the main quality control tool used to identify and weed out incompetent physicians. Hospitals, however, are intentionally circumventing their reporting requirements to avoid institutional embarrassment, medical liability, and physician alienation. This negatively impacts the ability of the more than 24,000 entities that query the NPDB to effectively determine whether a practitioner is competent for purposes of licensing, hiring, and credentialing. This Article offers a solution—switch the data bank from a blacklist of incompetent providers to a database of the employment and hospital affiliation histories for all medical providers. Have the NPDB or private accreditation organizations require hospitals complete a mandatory questionnaire for all practitioners during the credentialing process. Implementing this solution will achieve three salient objectives: (1) improve the process whereby hospitals investigate whether a medical practitioner is competent to practice medicine prior to hiring or offering the practitioner privileges; (2) pave the way for state-based tort claims to hold hospitals accountable for inaccurate disclosures regarding a practitioner’s competence to practice medicine; and (3) eliminate the stigma associated with being listed in the NPDB which causes practitioners to practice defensive medicine and avoid admitting mistakes.