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04.27.2022 Physician Group Monitoring of “Open Payments” By: Joy Heath & Sarah G. Caron

Is your physician group monitoring the Open Payments database? Each June, the Centers for Medicare and Medicaid Services (CMS) releases data showcasing the payments made by reporting entities to physician groups and other health care providers.

CMS requires drug, medical device, and medical supply manufacturers and others to disclose payments and other “transfers of value” made to covered entities such as physician groups. Under CMS’s required reporting guidelines, manufacturers and other entities must disclose their payments to doctors whether in the form of charitable contributions, consulting fees, or monies paid for grants, gifts, entertainment, meals, travel or research.

Amid heightened government scrutiny of the lack of transparency in the health care system, the U.S. Department of Justice and the U.S. Department of Health and Human Services’ Office of Inspector General have made it a priority to enforce Open Payments violations under the Sunshine Act as well as the Anti-Kickback Statute.

While the duty to report falls on the manufacturers, physician groups should be mindful of the Open Payments program and consider regularly accessing the data available on the CMS Open Payments site. Physician practices can:

  • Review Open Payments data (both by organization and individual providers) for accuracy and to determine whether the payments raise any questions;
  • Examine only a subset of the highest-risk individual providers or analyze the entire data set using advanced analytics software;   
  • Evaluate reported data to ensure the adequacy of the practice’s processes for verifying and documenting the business need for all payments;
  • Update conflict of interest policies to include spending limits and approvals; and
  • Assess adherence to compliance policies relating to the receipt by physicians of funds and items of value.

For more information, please contact Joy Heath (919.981.4001 or jheath@williamsmullen.com) or Sarah Caron (804.420.6072 or scaron@williamsmullen.com).