Under the Sunshine Act, vendors must post the names of every provider they have a financial relationship with — and this means even accepting lunch from a drug rep will land your name on the Open Payments list. If you find out your name is listed inaccurately, you can dispute it. The problem is that many providers don’t know whether their names should be on there or not.
Check out four considerations to show whether the Sunshine Act applies to you, along with a timeline on when to dispute it if your name is inaccurately listed online.
1. Applicable Manufacturers Must Report
Any entity that manufacturers drugs, biologics, supplies or devices that are covered by Medicare, Medicaid or CHIP must tell the government when they’ve transferred money or anything else of value to a physician, a physician’s assistant, nurse practitioner, clinical nurse specialists, certified nurse anesthetists or a certified nurse midwife. They do this once a year by posting the names of those providers online through a portal known as the Open Payments site.
In some cases, even immediate family members of these healthcare providers can’t accept anything of value from an applicable manufacturer.
2. Value Transfers Must Total $12.69 or More
The value of the transfer must be $12.69 or higher in 2024, although this number does change annually. Therefore, transfers that are valued at $12.68 or lower won’t qualify. However, it’s very important that you pay attention to the items that applicable manufacturers give to your staff.
For example: Suppose a pharma rep comes to your practice and brings donuts. The donuts are worth $10.00, so they are below the threshold and the pharmaceutical firm will not add your provider’s name to the online listing under the Sunshine Act.
However, let’s say that pharma rep comes back every month and brings donuts each time. By the end of the year, the total has exceeded $12.69 and therefore the pharmaceutical firm must report your providers as part of the Sunshine Act.
This is why it’s vitally important to track everything your practice receives from applicable manufacturers. Even though a $5.00 coffee here and there doesn’t seem like much, you’ll need to add together the value of what each rep gives you over the course of a year to determine whether you’ve hit the $12.69 threshold and if your name is accurately on the list or not.
3. Consulting Fees, Charitable Contributions Count
Many providers will say they don’t belong on the list because they never accepted money or gifts from a manufacturer, but on deeper review they’ll realize they accepted a contribution to their charity or a consulting fee from the manufacturer. Those both count toward the Sunshine Act allotment.
So do funds that go toward education, research, debt forgiveness, serving as faculty, loans, acquisitions and more.
4. Product Samples Don’t Count
One common question is whether a pharmaceutical firm’s product samples count, but they are listed as exceptions to Sunshine Act reporting as long as you don’t sell them and they’re only provided for patient use.
Know How to Dispute When Needed
If you find your name on the Open Payments list and you know it’s there in error, you can dispute it. The annual reporting period from applicable manufacturers goes through March 31 each year, and you have from April 1 until May 15 to dispute issues or propose corrections. It’s very important to meet these deadlines if you want to ensure your practice isn’t erroneously posted on the Open Payments site.
If you have any confusion about whether your name belongs on the Open Payments list under the Sunshine Act — or you need help disputing your listing — talk to a qualified healthcare attorney.
There’s so much more to know about Sunshine Act reporting, and healthcare attorney Ritu Kaur Cooper, Esq. is here to help. Register for her hour-long online training, Sunshine Act: Quickly Identify & Resolve Errors to Protect Providers, today!
Check out our Practice Management Playlist on YouTube for the latest expert advice, and subscribe to our YouTube channel for step-by-step guidance!
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