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Centers for Medicare & Medicaid Services to Publish Health Care Providers’ Financial Info in September 2014

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In accordance with the recently launched "National Physician Payment Transparency Program," also referred to as the "Sunshine Act," the Centers for Medicare and Medicaid Services (CMS) will begin publishing online searchable information with regard to physician and hospital payments and ownership interests.

Information reported under the Sunshine Act is set to include payments made to physicians by manufacturers engaged in the production of products eligible for payment under Medicare, Medicaid, of the Children's Health Insurance Program (CHIP).  Financial relationships among physicians, their immediate family members, and manufacturers/group purchasing organizations will also be reported, including those in the form of stock, stock options, partnership shares, and memberships in limited liability companies.  The Sunshine Act will also require reporting of payments, compensation, expenses, and other contributions given to physicians on behalf of manufacturers/group purchasing organizations, irrespective of whether they are related to a covered drug or device.

In light of the growing concerns over conflicts of interests in patient care and research, the Sunshine Act is intended to increase transparency within the health care field, as well as facilitate increased prosecution under fraud and abuse statues like the Stark Law, anti-kickback statutes, and the False Claims Act.  Generally, these laws impose civil and criminal penalties on physicians for a) referring patients to health care services in which the physicians or their immediate family members have a financial interest, b) offering or accepting payment for referrals of Medicare or Medicaid services, or c) presenting a false claim for government payment.

While physicians are not required to take any affirmative action in response to the Sunshine Act, physicians are encouraged to register with CMS so that they may be given the opportunity to review any information before it is published.  Specifically, the Act provides a 45 day notice period for the information to be reviewed and, if necessary, corrected.  If the 45 day period lapses without a review by the physician, the information may still be reviewed and disputed, albeit at the risk of not having the changes reflected immediately.

Further information on the Sunshine Act can be found by visiting the CMS website, HERE.


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