Sunshine Act: How to Challenge a Claim

Healthcare Training Resource
October 11, 2013 — 872 views  
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The Sunshine Act obligates drug, device, medical supply, Medicaid, children’s health insurance and biological product manufacturers to make clear statements and reports as per US law. Any entity involved in the process of transferring, storing or marketing and distributing such products also come under the clauses of the Act.

The main aim of the Act is to protect citizens from manufacturers that may compromise on regulatory standards and jeopardize the safety of end users. Manufacturers and small facilities alike are asked to send reports to the CMS (Centers for Medicare and Medicaid Services). However, it is also important to be aware of the process of challenging a claim under the Act.

It is also important for physicians and immediate family of physicians to report ownership interests that they hold. Most of the data that is collected will be made publicly available on a website. However, there are times when the information portrayed is not fully accurate because of a faulty process of gaining data. In such cases, physicians can rightfully challenge the claims that are made public. It is best to review the data that is made public and file for changes even where the information is accurate, but misleadingly portrayed.

Indirect Payments and Third Party Payments to Physicians

In most cases, the damage to a physician’s reputation comes from data gathered in these specific parts of the published claims. All physicians get a minimum of 45 days to view and challenge reports before they are publicly announced. CMS gives physicians access to their information, and give them this time to contact manufacturers and GPOs (Group Purchasing Organizations) in case any of the information is misleading or inaccurate.

If these firms are unable to make the changes in time, the physician and the companies are granted an extra 15 days to resolve the matter. If the discrepancy cannot be amended even after this extension, the data will be flagged. However, the information will still be uploaded on the public site. In this case, physicians are allowed to challenge the information put up for as long as two years after it is uploaded.

After CMS has finalized their online portal, it will be necessary for physicians to register with their site so that they get a constant report as to when the next entries will be made on the website accessible by the public. If you have ownership interests in any of the companies involved, it is important that you check whether these are individual securities or bonds that come as a part of mutual funds.

Ownership Rights in the Form of Securities and Mutual Funds

Ownership rights and investments that fall under mutual funds are exempted from public reports. This information can help you make sure that your reviews are accurate. The physician portal is extremely important. Ensure that you review any information put on this portal because the data published on the public website will be a replica of the same. Making required changes before a public announcement can help you avoid any unnecessary tarnishing of repute.

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