Deadline to Dispute Reported Data Looms

By: Kathleen Quiroz and Clifford E. Robertson
Monday, December 15, 2014
Specialty: 

Concerned patients and investigative government officials will now have an easier time searching online for reported payments or other transfers of value made to physicians by manufacturers of drugs, medical devices, biologicals, or medical supplies covered by U.S. federal health care programs.

On Oct. 17, 2014, the Centers for Medicare & Medicaid Services (CMS) added a more user-friendly beta search tool to its Open Payments website that will allow users to search for physicians by name. This improvement to the Open Payments website comes as the deadline for reviewing and disputing reported data draws near.

Enacted in 2009 as part of the ACA, the Physician Payment Sunshine Act requires manufacturers of drugs, medical devices, biologicals, or medical supplies and applicable group purchasing organizations that participate in U.S. federal healthcare programs to report payments and other transfers of value to physicians and teaching hospitals, as well as certain ownership and investment interests. Distributors and wholesalers that hold the title to drugs, medical devices, biologicals, and medical supplies covered by U.S. federal healthcare programs are also required to report payments and other transfers of value to physicians and teaching hospitals. The Sunshine Act authorizes the public disclosure of the reported data on the Open Payments website.

Public Disclosure

Public disclosure of the reported data may subject physicians to increased scrutiny from patients and state and federal enforcement authorities. Physicians could be especially targeted, if the data disclosed is excessive or abnormal due to inaccuracy. For this reason, the Sunshine Act gives physicians the opportunity to review and affirm or dispute reported data. Physicians must keep in mind the reported data disclosed on the Open Payments website can be inspected by patients or government officials, so it is highly recommended that physicians visit the Open Payments website and review the reported data when given the opportunity.

Key Dates and Deadlines

Physicians may review and affirm or dispute reported data during a 45-day period prior to the publication of the data on the Open Payments website. Once the review and dispute period closes, physicians have 15 days to resolve and submit corrections. If disputes are not resolved by the end of the 15-day period, the reported data will be made public as submitted, but marked disputed.

Unfortunately, the 45-day review and dispute period for reported data has passed. On Sept. 30, 2014, CMS posted the first set of reported data on the Open Payments website. Physicians who did not initiate disputes during the 45-day review and dispute period may do so until Dec. 31, 2014. Any changes resulting from disputes initiated outside the 45-day period, but before Dec. 31, 2014, will not be made until the next time the data is refreshed on the Open Payments website in 2015.

Three-step Process to Review and Affirm or Dispute

Physicians may review and affirm or dispute reported data by completing the following three steps:

Step 1: Complete the CMS e-verification process via the CMS Enterprise Portal on the CMS.gov website.

Step 2: Register with the CMS Open Payments System. Consult the Quick Reference Guide on the CMS.gov website for assistance.

Step 3: Review and affirm or dispute data by Dec. 31, 2014. CMS has indicated that it will not resolve disputes. Physicians can report errors to manufacturers through the Open Payments System or directly through Open Payments contacts listed on most manufacturer websites.

Physicians who have financial relationships with applicable manufacturers, distributors, wholesalers or group purchasing organizations should consider joining the Open Payments electronic mailing list on the Open Payments website. The mailing list provides updates on upcoming important dates and deadlines, including the date the 45-day review and dispute period begins in 2015. Further, physicians who have not already taken the opportunity to review the reported data on the Open Payments website are encouraged to do so as soon as possible. The deadline to dispute the reported data is Dec. 31, 2014.


Kathleen Quiroz and Clifford E. RobertsonKathleen Quiroz, Partner, and Clifford E. Robertson, Associate, are members of the Strasburger & Price, LLP’s Health Law Practice Unit in San Antonio. They can be reached at 210-250-6000.