A blog by attorneys for anyone interested in or affected by The Sunshine Act.

Dispute and Resolution for Physicians and Teaching Hospitals

April 3, 2014
Ruselle W. Robinson

I am focusing today on the Sunshine Act dispute and resolution process through which “physicians” and teaching hospitals can dispute inaccurate payment data. I used quotation marks around the term “physicians” because “physicians” includes medical and osteopathic doctors, dentists, dental surgeons, chiropractors, optometrists and podiatrists. CMS defines teaching hospitals by publishing an annual list of teaching hospitals that are subject to Sunshine Act reporting. The teaching hospital list for 2013 reporting can be found here.

As described below, physicians and teaching hospitals will be given an opportunity to review and dispute payment data that applies to them after applicable manufacturers and “applicable group purchasing organizations” have submitted their 2013 payment data and the Phase 2 submission process has been completed.

The definition of an “applicable group purchasing organization” (GPO) is an entity that operates in the United States and purchases, arranges for or negotiates the purchase of covered drugs, devices, biologicals, or medical supplies for a group of individuals or entities, but not solely for use by the entity itself. The reporting requirements for applicable GPOs are limited to (i) ownerships held by physicians or their immediate family members, and (ii) payments and other transfers of value from an applicable GPO to a physician holding an ownership or investment interest in the applicable GPO.

The Phase 1 registration and data submission for applicable manufacturers and applicable GPOs has ended. CMS intends to commence the Phase 2 submission of payment data in May. Phase 2 will continue for at least 30 days.

After the close of Phase 2, CMS will announce the opening of voluntary registration for physicians and teaching hospitals. The voluntary registration of physicians and teaching hospitals is scheduled to start no later than August 1, 2014. Registration will be open-ended.

You should register with CMS if you believe you received a payment or transfer of value from an applicable manufacturer or applicable GPO in 2013 (August 1, 2013 through December 31, 2013). If you register, you will be allowed to review payment data submitted by applicable manufacturers and applicable GPOs that apply to you. You can dispute any incorrect payment data. You will be given this opportunity before the data becomes public.

CMS has a target date of September 30, 2014 for posting the initial 2013 payment data on a website.

Here is the timetable for dispute and resolution of 2013 data:

On or before August 1: CMS will open physician and teaching hospital registration. CMS also will commence the sixty (60) day dispute and resolution process. Applicable manufacturers and applicable GPOs will provide registered physicians and teaching hospitals with 2013 payment data that applies to them.

Day 1 through Day 45 of Dispute and Resolution Process: Registered physicians and teaching hospitals can dispute incorrect payment data reported about them with the reporting applicable manufacturers and applicable GPOs. CMS will not mediate the disputes. If corrections to reported data are agreed to, the reporting applicable manufacturer and/or applicable GPO must send CMS a revised report, and re-attest to the payment data.

Corrected payment data reports resulting from disputes initiated during this 45-day period and submitted before day 60 of the dispute and resolution process will be included in the initial public data. Disputes initiated during this 45-day period that remain unresolved at the end of day 60 will be posted to the public as originally submitted, but CMS will show the data as under dispute.

Filing a dispute with the applicable manufacturer or applicable GPO within the initial 45-day window of the dispute and resolution process will give you the best opportunity to avoid having CMS post incorrect payment data about you.

Day 46 through Day 60 of Dispute and Resolution Process: Registered physicians and teaching hospitals can initiate disputes during this 15-day period and work with reporting manufacturers and GPOs to resolve their differences. However, an applicable manufacturer or applicable GPO is not required to submit revised payment data to CMS even if there are agreed-upon corrections. If an applicable manufacturer or applicable GPO does submit corrected data, CMS may not include the corrections in the initial public posting of data.

You can continue to negotiate with an applicable manufacturers or applicable GPOs past the end of the 60-day dispute and resolution process. Applicable manufacturers and applicable GPOs can submit corrected data at any time. CMS will update data from the current and previous year at least once annually, including data corrections submitted since the last update.

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