By John Fisher, JD, CHC, CCEP
Challenging Physician Payment Sunshine Act Disclosures
Legal Strategies and Considerations for Healthcare Providers
The Physician Payment Sunshine Act, implemented through the Open Payments Program, was established to increase transparency in financial relationships between healthcare providers and pharmaceutical or medical device manufacturers. Manufacturers must report certain payments and transfers of value made to physicians and teaching hospitals, and CMS publishes that information in a public database. For providers, the transparency purpose does not eliminate the risk created by inaccurate data: incorrect or misleading disclosures can affect reputation, credentialing, professional relationships, and regulatory scrutiny.
Understanding the Sunshine Act Reporting Process
Each year, manufacturers submit data to the Centers for Medicare & Medicaid Services (CMS) detailing payments, gifts, meals, travel, and other transfers of value. Before the information is published, physicians and teaching hospitals have a limited 45-day window to review and, if necessary, dispute the data. It is crucial for providers to be proactive in monitoring these reports, as errors can occur due to administrative oversights, miscommunication, or incorrect attribution of payments.
Because CMS review and dispute windows are time-limited, providers should treat Open Payments review as an annual compliance workflow rather than a reactive task. Assigning responsibility before the review period opens, preserving manufacturer communications, and preparing standard documentation templates can help providers identify errors quickly and preserve the strongest record for any dispute.
Grounds for Challenging Disclosures
Common reasons to challenge a Sunshine Act disclosure include incorrect dollar amounts, misclassified payment categories, erroneous recipient identification, and duplicate entries. Providers may also dispute payments that were never received or were attributed to the wrong individual or entity. Left uncorrected, these inaccuracies can create a public record that misstates the provider’s industry relationships and may invite unnecessary reputational, credentialing, or regulatory scrutiny.
Steps to Dispute a Reported Payment
- Register with the Open Payments System: Providers must first register with the CMS Open Payments portal to access and review reported data.
- Review Data Promptly: Carefully examine each reported transaction during the review period, looking for discrepancies or unfamiliar payments.
- Initiate a Dispute: If an error is identified, submit a dispute through the Open Payments system, providing supporting documentation and a clear explanation of the issue.
- Engage with the Reporting Entity: Manufacturers are required to respond to disputes and work with providers to resolve issues before the data is finalized and published.
- Follow Up: If a dispute is not resolved during the initial review period, providers may continue to work with CMS and the reporting entity, and unresolved disputes can be flagged on the public database.
Providers should also understand the practical limits of the dispute process. CMS facilitates the review and dispute mechanism, but the reporting entity generally remains responsible for correcting or confirming the submitted data. If a dispute remains unresolved, the public record may still be published with a dispute notation rather than removed entirely. Setting expectations at the outset helps providers decide when to escalate, when to preserve evidence for later use, and when reputational or regulatory risk may justify additional legal action.
Legal Strategies and Best Practices
Given the reputational and regulatory stakes associated with public disclosures, legal counsel can help providers navigate the dispute process without overstating or omitting key facts. Attorneys can assist with gathering relevant evidence, drafting communications to reporting entities, preserving records of the dispute, and monitoring compliance with applicable review timelines. Maintaining thorough records of manufacturer interactions and keeping personal logs of industry-related payments can also make the review and dispute process more efficient.
Law firms can also assist clients in understanding the broader implications of Sunshine Act disclosures, including potential impacts on credentialing, reputation, and government investigations. Early and proactive engagement is key to protecting professional standing and minimizing legal risks.
Conclusion
Challenging inaccurate Physician Payment Sunshine Act disclosures requires diligence, organization, and timely action. Providers who monitor Open Payments data, preserve supporting records, engage promptly with reporting entities, and involve legal advisors when appropriate are better positioned to correct public records and protect their professional integrity.
