Federal prosecutors search for outliers in Open Payments data

Federal investigators and prosecutors are mining the treasure trove of data within the Centers for Medicare & Medicaid’s Open Payments program to identify spending outliers and solidify whistleblower claims, according to PharmExec.com.

Thanks to the Physician Payment’s Sunshine Act, which requires pharmaceutical and device manufacturers to report their financial relationships with healthcare providers, federal officials now have a larger breadth of payment information to pursue fraud investigations. Over the last three years, CMS has collected and published more than 28 million records tied to nearly $17 billion payments.

The law could be lucrative for federal officials. According to PharmaExec.com, CMS plans to fund the program through civil penalties, which will influence enforcement activity. Anti-kickback violations are a key target for prosecutors, particularly those that could induce providers to order more expensive drugs that are reimbursed by Medicare.

Certain spending trends point to emerging concerns. For example, this year’s release showed a spike in charitable contributions and grants. Previous studies have shown that the amount of money physicians receive varies widely depending on their medical specialty.  

- read the PharmaExec.com article