CMS Rejects One-Third of Industry Open Payments Reports, Threatens Fines

The Centers for Medicare and Medicaid Services (CMS) is returning one-third of the records submitted by device and drug makers under the Physician Payments Sunshine Act.

The agency told ProPublica on August 15, 2013 that there too many errors and might even level fines if further mistakes are made. The remaining two-thirds of the records will be released in September.

The launch of the Open Payments database was recently delayed when a Louisville, Kentucky, electrophysiologist named, David E. Mann, M.D., complained that payments were being attributed to him even though they were made to another physician with the same name. ProPublica‘s Charles Ornstein wrote that in the process of reviewing that complaint, the agency found “intermingled data, ” where physicians were being linked to medical license numbers or national provider identification numbers that were not theirs.

Intermingled Data

“CMS is returning about one-third of submitted records to the manufacturers and [group purchasing organizations] because of intermingled data, and will include these records in the next reporting cycle, ” CMS spokesman Aaron Albright wrote to ProPublica by email. These records won’t be posted until June 2015.

While CMS didn’t say how many records were involved, the number of records withheld could be in the millions, if not tens of millions.

The first release, slated for September 30, will include all payments made from August 1 to December 31, 2013.

Ornstein also reported that some physicians told him that some data being removed from the system was actually accurate.

“Mann, whose initial complaint took the system offline, said he logged into the verification system yesterday and discovered that payments that had been legitimately credited to him were no longer visible. He said only three entries currently show up, even though there were several other legitimate ones from device maker Medtronic that disappeared, ” wrote Ornstein.

Another electrophysiologist, Edward J. Schloss, M.D. of Cincinnati, said that some seemingly legitimate payments attributed to him from Medtronic, Boston Scientific and Pfizer disappeared when he logged in on August 14. “It’s a big change, ” he said. “Three of the four companies that have reported payments for me have now disappeared.”

CMS’ Albright said consumers will be provided with an explanation about the missing payments when the public database is launched. Doctors said they did not see such a notice on the verification site.

In a separate glitch, Ornstein wrote that CMS also appears to have fixed a message that had appeared on the verification site for physicians who have no payments attributed to them. Weeks ago, an error message appeared that said, “You have the following errors on the page: There are no results that match the specified search criteria.”

Now the site says, “There are no payments or other transfers of value or ownership or investment interests reported for you or your family members.”

Check Your Data!!!

As we reported previously, if you have any concerns about the data’s accuracy, this is the time to dispute and correct the data submitted by industry. Physicians and teaching hospitals can register in Open Payments to review their payments.

For tutorials, information and a quick reference guide, visit: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/Physicians.html

If you have logged onto the site and have experienced problems or inaccuracies, we’d like to hear about it. Contact Walter Eisner at walter@ryortho.com.