The Centers for Medicare & Medicaid Services (CMS) released this month the 2012 Medicare payment data for individual physicians.  CMS also recently wrapped up its Phase I collection of data related to payments and transfers of value from pharmaceutical, medical device and biotechnology manufacturers and group purchasing organizations to physicians and teaching hospitals that will be released in the fall of 2014.  Industry should be prepared for this explosion of publicly available data to have significant consequences in government investigations, qui tam whistleblower suits, and other government activity to combat fraud, waste, and abuse in the health care industry.  One only needs to look at the industry watchdog ProPublica website to see one way in which this information is being used by the media.

Access to these comprehensive, aggregated and usable data sets is a new frontier for many companies.  Compliance-oriented companies will use this data for auditing, monitoring, and other compliance activities designed to identify and remedy potentially problematic activity.  This is because companies will not be limited to identifying a specific problematic payment, but we will be able to identify and analyze patterns and trends within the data.  Industry should expect to see an increase in the number of companies using data analytics and other advanced analyses to cull this data in new ways.

Companies preparing for the release of the Sunshine data late this year also should be using this opportunity to identify specific payments, patterns and trends in the payments and transfers of value data that may raise public concern or the attention of media.  Companies will then have the opportunity to prepare in advance its strategy and response to these items.

Posted by Cooley

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