Corporate compliance for physicians

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Sunshine Act requires tracking of some physician, hospital payments

The Physician Payments Sunshine Act requires manufacturers of drugs, medical devices and biologicals that participate in U.S. federal health care programs to report certain payments and items of value given to physicians and teaching hospitals. There is a long list of what is and is not required to be reported. The Centers for Medicare & Medicaid Services (CMS) lists 14 categories of payments, such as consulting fees, grants, research, honoraria, travel and charitable contributions. If a physician requests that payment be made indirectly to another physician or third party, that payment must be reported, too. The payment type will be noted, as well (e.g., cash, stock, ownership interest, in-kind items/service, etc.).

What doesn’t count? The following don’t have to be reported under the Sunshine Act:
• CME credit and courses
• Conference buffet meals and drinks if available to everyone
• Patient product samples
• Patient educational materials
• Medical devices loaned for short-term testing
• Charity care items
• Payment for services rendered in legal actions
• Anything under $10 (unless in aggregate it amounts to $100 or more for the year).

Manufacturers, not physicians, are responsible for submitting reports to CMS. Physicians should review the information when available since it’s the physician’s name and reputation at stake.

Important dates related to the Sunshine Act:

Aug. 1 – Dec. 31, 2013

Manufacturers were required to begin collecting and tracking payment, transfer and ownership information. Thereafter, they are required to report for each full calendar year.

Jan. 1, 2014

CMS launched the physician portal that allows physicians to sign up to receive notice when their individual consolidated report is available for review. This portal also allows physicians to contact manufacturers/group purchasing organizations (GPOs) if they want to dispute the accuracy of a report.

March 31, 2014

Manufacturers/GPOs will report the data for 2013 to CMS.

June 2014

CMS is expected to provide physicians access to an individualized, consolidated version of all manufacturers/GPO reports for the prior calendar year. Physicians may access the consolidated reports via an online website portal maintained by CMS and will be able to seek correction or modification by contacting the manufacturer/GPO through the portal.

Sept. 30, 2014

CMS will release most of the data on a public website.

Page last updated: 1/26/2016 3:22:42 PM