Importance of Monitoring the CMS Open Payment Program


As the CMS Open Payments program expands towards its 10-year anniversary in 2023, this is a key time for healthcare providers to enact basic compliance procedures that monitor the public database regularly. The database is expanding this year to include important categories of covered recipients, which providers will need to include in their conflict reviews.

For background, the Open Payments database was created to enable a range of healthcare manufacturers, including drug and medical device companies, make their federally mandated reports of payments to “covered recipients.” Penalties for failure to make these accurate and timely reports can be severe, so these groups are incentivized to report properly. The database serves as the public reporting tool that allows consumers, physicians and others to review and research financial relationships with providers that can cause a conflict.

The Open Payments program expanded in 2021 to include five new provider types as well as new payment types. June 30 of this year is when data that was collected last year by drug and medical device companies and submitted to CMS is expected to be published.

The new provider types included in the CMS Open Payments database are physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists and anesthesiologist assistants, and certified nurse-midwives. The types of payment reported are broad, and include consulting fees, ownership and investment interests, entertainment, travel and gifts, and the royalties or licenses. The database allows organizations to become informed about various potential conflicts of interest, standards for which should be stated in policy and adopted by the organization.

Your compliance program will need to identify those employees who now fall into the new provider categories and ensure that they are included in conflict reviews. Contact us with any questions regarding your compliance program.

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