On Friday, June 28, 2024, the Centers for Medicare and Medicaid Services (CMS) published the 2023 Open Payments data, along with newly submitted and updated payment records for program years 2017-2022. The 2023 data includes transactions from January 1st to December 31st. Applicable manufacturers reported $12.75 billion in reportable payments, ownership and investment interests to healthcare professionals and organizations (HCP/Os). This marks a $70 million decrease from the 2022 calendar year. Nearly 1,800 companies reported a total of 15.64 million records attributed to 630,384 physicians, 309,438 non-physician practitioners and 1,225 teaching hospitals.

Non-physician practitioners accounted for 33.74% of the reported records but only 4.8% of the total dollar value of payments. This indicates that while non-physician practitioners are receiving a substantial number of the payments, they tend to be smaller value transfers, such as meals and educational items, rather than larger payments often given for bona fide services like consulting and research.

According to the data published by CMS, $3.29 billion of the total was attributed to general payments. General Spend is down by 10% from the previous year, particularly in the categories of Royalty/License and Acquisitions. However, Food and Beverage along with Travel are both up by 16%. Research Payments accounted for $8.12 billion which is up 4% but generally continuing the same trend as previous years. Ownership and Investment Interests accounted for $1.34 billion. This amount has remained steady over the past three years, with a dip in 2020 during the height of the pandemic.

Last year, 10 individuals received more than $50K in meals. That translates to an average of $137 per day! 100 individuals exceeded $10K – only two of them were non-physicians. Additionally, 22 physicians have received more than $100K in meals over the past five years.

Increase in Audit Awareness

In addition to the latest publication, there has been an increase in CMS audits of reporting entities. According to a recently published FAQ, CMS is using a “combination of risk-based criteria and random selection to identify reporting entities for audit.” Each audit will depend on the reason for the audit and the scope of the particular audit. Risk-based criteria can include, but are not limited to:

  • A prior history of non-compliance
  • Credible third-party compliance tips
  • Anomalies or inaccuracies in reporting data
  • Unusual or inconsistent reporting patterns

Companies should ensure ready access to all Open Payments information pertaining to compliance with reporting requirements. This may include receipts or checks, copies of contracts or agreements, standard operating procedures, employee trainings on tracking transfers of value and any other information pertaining to payments to HCP/Os. Any assumptions should be properly documented, along with evidence of role-based training and monitoring efforts by companies.

The publication of the 2023 Open Payments data, along with the updated FAQs and increased CMS audits, highlights the importance of reviewing and evaluating internal policies and procedures regarding HCP interactions. Ensuring timely and accurate reporting must remain a priority for applicable manufacturers. To learn more about how MediSpend can help support your Open Payments reporting obligations, please contact us.

The next Open Payments data update will take place in January 2025. The full set of the 2023 CMS Open Payments data can be found here: https://openpaymentsdata.cms.gov/.

 

Lauren Howe
Director, Compliance Solutions

July 18, 2024