Avoid Getting Burned by the Sunshine Act

You've probably heard of the Sunshine Act, but do you know what it means for radiologists?sunshine act

Does learning more about the Sunshine Act feature on your to-do list? Although the act does not require physicians to actually do anything, ignorance about its implications can have serious consequences.

Section 6002 of the Patient Protection and Affordable Care Act (PPACA), better known as the Sunshine Act, requires that medical device and drug manufacturers and vendors report any payments or other “transfers of value” made to physicians and teaching hospitals. The goal is to make transactions between physicians and manufacturers more transparent.1

For the first round of data collection, manufacturers have reported on information gathered between August and December 2013. From there, manufacturers and vendors will be required to continue to track and report payment data. Since physicians are not required to do any reporting, you might be asking why the Sunshine Act matters to you at all.

Although physicians are not required to review the information gathered, they will have the opportunity to do so. You should be aware that after September 2014, the manufacturer-reported information will be made public and posted on the CMS website. Media and federal institutions such as the IRS will be able to freely access and use this information. It can also be used in court, such as in divorce cases or in qui tam cases (lawsuits brought by a whistleblower alleging the organization made a false claim to the U.S. government).2

IRS and Department of Justice officials will be looking at these data to make sure the payments are reported properly in accordance with the Sunshine Act. The PPACA has strengthened several of the government’s anti-fraud tools, including the Anti-Kickback Statute, an act that provides criminal penalties for soliciting or receiving anything of value in an effort to induce patient referrals. Under the new terms, a person does not need to have specific knowledge or intent of fraud to violate the statute. This makes it easier for the federal government to pursue claims of fraud — all the more reason to follow up on information being reported about you.

What can you do to ensure that the correct data is being reported? CMS has been working to make disputing the manufacturer’s claim (fairly) painless. By the end of March 2014, manufacturers and vendors will be required to submit the data for August to December 2013 to CMS, which will post it for review between June and August 2014. Physicians will have until September to access these reports via an online web portal. During this review period, the information will not be public, and physicians will only be able to view their own information.

If you disagree with any of the information, you can initiate a dispute through the website. CMS will then contact the applicable manufacturers that may have reported incorrectly. If the manufacturer believes it has reported correctly, you can continue disputing the claim for as long as you wish. However, if the data is not resolved and agreed upon by both parties by September, it will be published but will be flagged as disputed until settled.2

While logging in and reviewing these data may seem like a burden, it may prevent future difficulties.


By Meghan Edwards

 

ENDNOTES
1. Silva E. “Shining Light on the Sunshine Act." JACR 2013;10(9):652–53. http://bit.ly/Sunshine-Silva. Accessed Nov. 13, 2013.
2. Sullivan T, Eigner M. “Physican Payment Sunshine Act, Lessons Learned in Preparation and Implementation.” Webinar; http://bit.ly/SunshineWebinar. Sept. 04, 2013; Columbia, MD.

 

Other Suggested Resources
AMA Toolkit for Physician Financial Transparency Reports: http://bit.ly/SunshineToolkit
RADLAW column on the Sunshine Act: http://bit.ly/SunshineRadlaw
Free App for Tracking Information and Payments: http://bit.ly/SunshineApp
Overview of State Sunshine Laws: http://bit.ly/AMASunshineLaws

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