CMS Releases App To Streamline Open Payment Program

by Peter Budetti, MD, JD

I’m excited to announce that we have released two apps to help physicians, manufacturers, and Group Purchasing Organizations (GPOs) track data for the Open Payments program, which was created through the “Sunshine” provision of the Affordable Care Act.  Use of the apps is entirely voluntary. Importantly, these apps are for information collection and storage only.  Having this mobile tool at your fingertips will make data much simpler to track and report.

The mobile apps are available to help physicians and others track payments and other information they receive throughout the year. This is intended to make annual reporting easier and ensure greater data accuracy.  CMS’ foray into mobile technology is about providing user-friendly tools for doctors, manufacturers and others in the health care industry to use in working with us to implement the law.  These two apps are an innovation option for doctors and industry to accurately and securely track their financial ties and other transfers of values as required under this transparency program created by the Affordable Care Act.

New Open Payments Apps available for download

The Open Payments law is designed to improve transparency to sustain patient care and trust as the highest priority by allowing the public to be informed about financial relationships that could influence the drugs, devices, biological, or medical supplies used in health care delivery.

To facilitate transparency and to keep patient care and trust as the highest priority, CMS has developed these apps to help physicians and others managed their oversight of information about their financial relationships that companies will report to Open Payments. We developed these apps to reduce the reporting burden by providing tools to simplify the tracking process and help improve data accuracy reporting for the industry (manufacturers and GPOs).

Using the Apps

Physician and industry users can track events and payments together using these apps for individual tracking purposes by either just the physician or just the industry user.  If they want to use the apps collaboratively, they can exchange many types of information, in real-time, to help ensure that physician information that the industry must supply to CMS in formal reporting such as  name, business address, and National Provider Identifier (NPI), is collected accurately. They can also collaborate on the interaction and payment that occurred to ensure everyone is on the same page.

Here is an example of how a physician could use the app to track payments received:

A physician receives a consulting fee from a drug manufacturer. The physician doesn’t have a reporting requirement under the Open Payments program, since all reporting is done by manufacturers and other companies, but she wants to be sure that the drug manufacturer accurately reports the consulting fee to CMS. Using the physician app, she can record a detailed summary of the transaction for her own records – by manually entering the data.

And here’s an example of how a doctor collaborates with the health care industry using the app:

The physician can use the “Read Quick Response (QR) Code” functionality that allows the manufacturer to create a record of the interaction and transfer it to the physician for her review.

Additionally, to help ensure the drug manufacturer correctly attributes the consulting fee to her, she can share her profile information with the drug company using the “Create QR Code” function. Months later, when she is reviewing the data the drug manufacturer reported to CMS, and before the data is made public, she can retrieve her original record from her mobile device and do a comparison to confirm that the information is correct.  If she believes the information that the manufacturer submitted to CMS about a particular interaction is not accurate, she can work with the manufacturer on correcting the information prior to publication.

Note that CMS will not validate the accuracy of data stored in the apps, nor will it be responsible for protecting data stored in the apps.  Reporting entities have sole responsibility for the accuracy and completeness of the data submitted to CMS under Open Payments.  

To download the mobile apps free of charge, for both Android and Apple platforms, users should visit the Google Play Store™ or iOS Apple™ Store and search for “Open Payments.” Once the chosen app has been installed, the user will be prompted to establish a password to ensure data security and privacy. That’s all it takes to get started.

Questions

This is an exciting time for CMS, as we’re able to harness the power of mobile technology to enable successful program implementation. Frequently Asked Questions about the apps and how they can be accessed and used are available on the Open Payments website. For any questions relating to Open Payments, contact the Help Desk at OpenPayments@cms.hhs.gov.

Fighting Health Care Fraud

The Obama Administration has made fighting health care fraud one of our top priorities.  In Medicare and Medicaid, these efforts are already paying off.  This year, we announced a record recovery of $4.1 billion in taxpayer dollars. Four years ago, that number was only a little more than $1 billion.

These efforts reflect a broad range of steps we have taken to improve our ability to detect and go after fraud.  For instance:

•             Under the Affordable Care Act, we have new authorities to fight fraud.  This includes additional scrutiny for higher risk categories of providers and suppliers before they’re able to bill Medicare, Medicaid and the Children’s Health Insurance Program (CHIP); and new authority to suspend payments during the investigation of fraud.

For example, this week we suspended payments to home health providers in Texas related to a recent fraud bust.

•             We’ve instituted tougher new rules and sentences for criminals.  From 2008 to 2011, there has been a 75 percent increase in individuals charged with criminal health care fraud.

•             We are implementing a ground-breaking Healthcare Fraud Prevention Partnership, where the federal government and private and state organizations, including insurers, work together to prevent health care fraud.

•             And we have implemented a new Fraud Prevention System that uses predictive modeling technology, similar to the technology that credit card companies use to flag suspicious activity, to review medical claims before they are paid.

Today, we released a report on the first year results of the Fraud Prevention System (http://www.stopmedicarefraud.gov/fraud-rtc12142012.pdf). Since the technology was first rolled out in 2011, all Part A and B Medicare claims – over one billion – have run through the system.   In the first year in operation, the system initiated 536 new investigations and helped stop, prevent, or identify an estimated $115 million in fraudulent payments.

We are working to continue improving our system and refine the way we track our results.  Our law enforcement partners have made important suggestions on how to improve our metrics for reporting these savings, and we are working to implement their recommendations.  They agree – this is an important system that will strengthen our efforts to fight fraud, waste and abuse.

Fighting fraud continues to be a top priority for the Administration, and we will continue implementing innovative new approaches that will protect taxpayer dollars.  For more information on our efforts to fight fraud, please visit: http://www.healthcare.gov/news/factsheets/2011/03/fraud03152011a.html.

Command Center Speeds Up Anti-Fraud Efforts

By Dr. Peter Budetti, CMS Deputy Administrator and Director of the Center for Program Integrity

Today, I had the privilege of joining HHS Secretary Kathleen Sebelius and CMS Acting Administrator Marilyn Tavenner to open the new CMS Program Integrity Command Center that is speeding up the process of identifying fraud, and stopping criminals from defrauding Medicare and Medicaid.

The new Command Center is bringing together Medicare and Medicaid officials, as well as law enforcement partners from the HHS Office of the Inspector General, the Federal Bureau of Investigation, and CMS’s anti-fraud investigators. The Command Center will gather experts from all different areas – clinicians, data analysts, fraud investigators, and policy experts – into the same room to build and improve our sophisticated new predictive analytics that spot fraud, and to then move quickly on a lead, once potential fraud is identified. The technology also allows us to connect with field offices to track down leads in real time.

The result is that investigations that used to take days and weeks can now be done in a matter of hours. And this new technology can help detect and prevent potential problems and payments. That can mean millions of taxpayer dollars staying out of the hands of fraudsters.

This is one more part of the Obama Administration’s effort to fight fraud and waste in our health care system. The health reform law gives law enforcement more tools to go after fraudsters, and establishes tougher sentences once we catch those criminals. We’re already seeing results – four years ago, the government recovered just over $1 billion in fraudulent payments; this year, it’s over $4 billion, a record number. We’ve had the largest health care fraud busts in history in 2012.

Below, view a preview of this exciting facility that’s helping us protect the Medicare and Medicaid programs:

Industry Day – By Peter Budetti, CMS Deputy Administrator and Director for the Center for Program Integrity

We at the Centers for Medicare & Medicaid Services (CMS) continue to ramp up our efforts to fight health care fraud as we welcome more than 330 people representing nearly 200 vendors to Industry Day on October 15 from 9:00 am to 5:00 pm at our Central Office complex in Baltimore, Maryland.  Our Center for Program Integrity (CPI) is hosting the event, which is designed to identify state-of-the-art services, methods and products that could help us to prevent and detect fraud, and to reduce waste, abuse and other improper payments under the Medicare and Medicaid programs.

Industry Day is the first of a two-phase market research initiative where we’ll be sharing our strategic goals, priorities and objectives to prevent and detect fraud.  We’ll also provide an overview of our capabilities and initiatives related to Medicare and Medicaid program integrity, including the process of developing IT solutions within the context of the CMS Technical Reference Architecture and Integrated IT Investment & System Life Cycle Framework.  Based on the information we present, interested vendors can determine if the services, methods and products they offer can support our fraud prevention efforts.

The second and final phase of our market research initiative will start in late November when we plan to send an online invitation (through the FedBizOpps website) asking interested vendors to submit capability statements for the following four areas:  provider screening, predictive modeling, case management and data integration.  We’ll review and select capability statements in each area and schedule meetings with some vendors starting in January 2011.

We look forward to seeing you tomorrow!

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