Does Medicare’s Transparency Program Show Kickbacks to Healthcare Providers?

The numbers are growing;  pharmaceutical companies and medical device makers are paying billions to doctors.  According to a June 30, 2015 news article these payments are in excess of $6 billion for 2014 alone.  The Centers for Medicare & Medicaid Services made this information available as part of their Open Payments Program in an attempt to provide “transparency to consumers.”  What are doctors getting paid for and what are we really able to see?

Although a great start, this transparency has limited substantive value. Although Pfizer, GSK and Merck are described as “big spenders,” in the news article, it is unclear precisely how that money was spent and allocated. Where did the money really go and to which of its many subsidiary companies? It is difficult if not impossible to track specific payments to physicians for grants, participation in studies, luxury food and travel that may have the scent of a kickback scheme. Payments alone do not prove bribes. So if you are looking for proof that your doctor being improperly influenced, look again. Many high ticket payments may be for legitimate educational purposes, studies or royalties.

To find real proof of improper influencing, i.e. kickbacks, you have to go a lot farther than a listing of payments; however troublesome the numbers may appear. The Anti-Kickback Statute specifically prohibits any person or entity from making or accepting payment to induce or reward referrals, recommending or arranging for the purchase of any item for which payment may be made under a federally-funded health care program. The Anti-Kickback Statute arose out of Congressional concern that payoffs to those who can influence healthcare decisions will result in goods and services being provided that are medically inappropriate, unnecessary, of poor quality, or even harmful to a vulnerable patient population. An illustration of this is a recent New York Times article in which a Nolan Auerbach and White partner was quoted.

Whistleblowers are needed to step forward to fill in the gaps as payments alone are not enough to prove a kickback scheme.  It is with the help of courageous whistleblowers that the payment of kickbacks and resulting patient harm can be curbed and eventually stopped.

More information for potential whistleblowers is located at the Nolan Auerbach & White website.