In September 2014, the Centers for Medicare & Medicaid Services began an annual, public release of data on physicians' and teaching hospitals' financial relationships with manufacturers and certain other entities under a program known as Open Payments. The program was stipulated by a physician “sunshine law” passed as part of the health care reform law. The aim of Open Payments is to ensure greater transparency about health care providers’ financial interests.
Physicians and hospitals have no data-collection responsibility. However, providers will be able to review and, as needed, correct their information before its public release.
Data Review Timeline
- Jan. 1–Dec. 31: Data collection by applicable manufacturers and group purchasing organizations (GPOs)
- Feb. 1–March 31: Payment data submitted by applicable manufacturers and GPOs
- April 1–May 15: Physicians and teaching hospitals can review and dispute data
- May 16–May 30: Applicable manufacturers and GPOs can review and correct data
- On or by June 30: Data is displayed on CMS
Who Must Report
The Sunshine Act applies to two main non-physician entities:
- Manufacturers of medical devices, drugs, biologicals and medical supplies operating in the United States, including certain wholesalers/distributors and certain entities under common ownership (5 percent or more) with a manufacturer (collectively, “Manufacturers”);
- Group purchasing organizations.
The Sunshine Law applies to all of the following types of doctors, as long as they hold a current license to practice in the United States:
- Doctors of medicine
- Doctors of osteopathy
Residents are excluded from the requirement (including residents in medicine, osteopathy, dentistry, podiatry, optometry and chiropractic).
Third-party entity recipients of a payment/transfer of value made “at the request of” or in the name of a physician or teaching hospital must be reported in the name of the physician and the recipient.
Doctors are subject to the law regardless of whether or not they are enrolled in Medicare, Medicaid or Children's Health Insurance Program.
Open Payments Program Expanded
The program was recently expanded to include other professional categories, items of value and requirements. Find more details about the changes.