Why the Sunshine Act Physician Payment Database Is a Failure

Recently, the media has sounded the alarm that healthcare providers are receiving billions of dollars a year from the pharmaceutical and medical device industries. This data was gleamed from recently released data made available under the federal Open Payments program. This federal initiative was created by the Physician Payments Sunshine Act, which requires manufacturers of drugs, devices and other medical supplies and group purchasing organizations to report certain payments to physicians or teaching hospitals.

This data, exposing the high amount of payola flowing to the doctors, is not new news for those in the healthcare fraud-fighting community. For the past decade, False Claims Act qui tam actions have uncovered untold billions of dollars in kickbacks influencing providers’ prescribing habits.

With that being said, only a small percentage of the payments catalogued in the Open Payments database are illegal kickbacks. Indeed, there are various legitimate reasons why a manufacturer might pay funds to a healthcare provider. For example, many physicians provide manufacturers with bona fide services, such as above-board consulting, scientific research, and speaking engagement.

The reality is that the government and the public cannot solely rely on the Open Payments data to distinguish between such valid compensation on the one hand, and illegal kickbacks on the other. This distinction can only be made with the help of a whistleblower, who can expose and detail, if so, the illegal quid pro quo intent behind the payments.

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