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Flying too close to the sun: Navigating changes to CMS' Open Payments program.

Kevin A Hickman¹

¹Kevin A. Hickman practices in neurosurgery at Geisinger Medical Center in Scranton, Pa., and is a doctoral student at A.T. Still University. The author has disclosed no potential conflicts of interest, financial or otherwise.

JAAPA : Official Journal of the American Academy of Physician Assistants

|September 28, 2021

Summary

This summary is machine-generated.

Physician assistants (PAs) and advanced practice nurses (NPs) face scrutiny for financial ties with healthcare manufacturers. The Open Payments program aims to increase transparency and prevent fraud, waste, and abuse in healthcare.

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Area of Science:

Healthcare Law and Ethics
Medical Economics
Regulatory Compliance

Background:

Financial relationships between healthcare providers (physician assistants, advanced practice nurses, physicians) and manufacturers are increasing.
These relationships can potentially influence medical decision-making, leading to patient harm and legal violations like the Anti-Kickback Statute (AKS) and False Claims Act (FCA).
In 2019, $2.6 billion was recovered by the federal government due to healthcare fraud and abuse.

Purpose of the Study:

To highlight the growing financial involvement between healthcare providers and manufacturers.
To underscore the potential risks and legal implications of these financial relationships.
To introduce the Open Payments program as a measure for increased transparency.

Main Methods:

Analysis of financial relationships between healthcare providers and manufacturers.
Review of legal statutes such as the Anti-Kickback Statute (AKS) and False Claims Act (FCA).
Description of the Centers for Medicare and Medicaid Services' Open Payments program.

Main Results:

Physician assistants' (PAs) and nurse practitioners' (NPs) violations contributed to significant government recoupment from healthcare fraud.
The Open Payments program is mandated to report financial relationships involving PAs and advanced practice nurses starting in 2022.
Increased transparency is a key objective to mitigate potential fraud and abuse.

Conclusions:

Financial ties between healthcare providers and manufacturers necessitate careful monitoring to protect patient welfare.
The Open Payments program is a critical regulatory tool to enhance transparency in the healthcare industry.
Adherence to federal and state laws is crucial for both healthcare providers and manufacturers to prevent fraud and abuse.