The Sunshine Act: An Overview
The following is a brief overview of the Sunshine Act and how it affects covered entities:
As part of the Affordable Care Act of 2010, the Sunshine Act was implemented in order to provide important ownership transparency by requiring applicable manufacturers and group purchasing organizations to report these items:
1.¬ ¬ ¬ ¬ ¬ ¬ ¬ ¬ payments or gifts to physicians, and
2.¬ ¬ ¬ ¬ ¬ ¬ ¬ ¬ physician ownership and investment interests.
The goal is to discourage conflicts of interest by making the information public.¬ Manufacturers and group purchasing organizations (GPOs) of drugs, devices, biologicals, or medical supplies covered by Medicare, Medicaid or the Children‚Ä™s Health Insurance Program (CHIP) must submit a report to the Secretary on certain payments or transfers of value they have provided to physicians or teaching hospitals (‚Äúcovered recipients‚ÄĚ) on an annual basis.
A ‚Äúcovered recipient‚Ä™‚ÄĚ is defined as:
1.¬ ¬ ¬ ¬ ¬ ¬ ¬ ¬ a physician, other than a physician who is an employee of an applicable manufacturer, or
2.¬ ¬ ¬ ¬ ¬ ¬ ¬ ¬ a teaching hospital
Physicians include doctors of medicine and osteopathy, dentists, podiatrists, optometrists, and chiropractors who have an active license to practice in their state, even if they do not bill Medicare or Medicaid.
In addition, these entities are also required to submit certain information on the ownership or investment interests of physicians or their immediate family. Some examples of these include stock, partnership shares, and limited liability company memberships.
The manufacturers must begin to collect the required data on August 1, 2013 (including a covered recipient‚Ä™s name, business address, NPI and specialty, dollar amount invested by each physician or immediate family member, etc.) and report it to CMS by March 31, 2014. The Secretary is then required to publish the submitted payment and ownership information on a public Web site, most likely by September 30, 2014. In the future, the data will be published by June 30th of each subsequent year.
It‚Ä™s important to note that covered recipients will be given the opportunity to review the data submitted to CMS at least 45 days before CMS makes the information public.¬ If the covered recipient disagrees with the data, they can dispute it with the reporting entity, not CMS. CMS will not be mediating disputes.
Additional information on the Sunshine Act can be found at: http://www.cms.gov/Regulations-and-Guidance/Legislation/National-Physician-Payment-Transparency-Program/index.html