CMS, HHS OIG Mull Punitive Use for Open-Payments Program, AIS Newsletter Reports

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The new open-payments program, which is used to identify potential conflicts of interest between medical device and pharmaceutical manufacturers, and physicians and teaching hospitals, could take on a new enforcement role, according to Atlantic Information Services’ Report on Medicare Compliance.

The Department of Health and Human Services Office of Inspector General (OIG) may use its new open-payments program for other uses, including enforcement, Atlantic Information Services, Inc.’s Report on Medicare Compliance reports in its July 13 issue. Currently, the Centers for Medicare & Medicaid Services (CMS) verifies the data and puts them into an “actionable format,” Shantanu Agrawal, M.D., director of CMS’s Center for Program Integrity (CPI), said at the American Health Lawyers Association’s annual meeting in Washington, D.C., on June 29, but OIG and CPI plan to look at the information to determine whether it is “useful for other purposes.”

“We are trying to be thoughtful in how we roll out those activities,” Agrawal noted. In the short term, the focus is on whether manufacturers are reporting the data and if that data is complete. Long-term, CMS will look at the quality of the data. If manufacturers fail to report transfers of value, Agrawal added, they could face civil monetary penalties.

The open-payments program, which was established in legislation contained in the Affordable Care Act (ACA), requires medical device and pharmaceutical manufacturers to report certain payments and other “transfers of value” (e.g., travel, grants, speaking fees, food, entertainment) to physicians and teaching hospitals to CMS. That information is available in a public, searchable online database. The database was updated with the first full year of data on June 30.

Visit http://aishealth.com/archive/rmc071315-02 to read the article in its entirety, which also details how the database is being put to use by compliance officers to monitor potential conflicts of interest.

About Report on Medicare Compliance
The industry's #1 source of timely news and proven strategies on Medicare compliance, Stark and other big-dollar issues of concern to health care compliance officers, the award-winning Report on Medicare Compliance identifies and provides valuable guidance on dozens of high-risk billing and documentation problems and foreshadows the next moves of federal enforcers and their armies of RAC, ZPIC and MAC auditors. “The best information there is for hospital compliance officers,” the 8-page weekly newsletter includes insights and strategies not available anywhere else.

Since 1992, Report on Medicare Compliance has been written by Nina Youngstrom, who has a reputation for being one of the most knowledgeable journalists and incisive writers in the field. With excellent contacts at the IG's office and at CMS, and strong relationships among industry experts and compliance officers, each issue of Report on Medicare Compliance contains exclusive, inside news. Visit http://aishealth.com/marketplace/report-medicare-compliance for more information.

About AIS
Atlantic Information Services, Inc. (AIS) is a publishing and information company that has been serving the health care industry for more than 25 years. It develops highly targeted news, data and strategic information for managers in hospitals, health plans, medical group practices, pharmaceutical companies and other health care organizations. AIS products include print and electronic newsletters, websites, looseleafs, books, strategic reports, databases, webinars and conferences. Learn more at http://AISHealth.com.

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