Keeping Healthcare Safe and Honest: A Simple Guide to OIG Screening and CMS Open Payments
- venops431
- 2 days ago
- 3 min read
When we go to the doctors to get help, we expect to be treated with respect and dignity. We count on the fact that whatever treatment we are receiving will work. However, how do we know the people giving us those treatments are trustworthy? How do we know that the medicines or treatments prescribed will work as expected and be the right ones for the diagnosis?
The good news is there are many ways the healthcare system tries to prevent anyone from committing any violations by establishing clear, consistent rules that provide complete transparency, honesty, and security for patients. The two major tools in making sure these things happen in the healthcare system are OIG screening and CMS open payments, which although they sound complex, they are really not. Now let's take a look at what they do and why they are so important to all of us!
What exactly does it mean when I say "OIG screening"?
When I use "OIG", I refer to the Office of Inspector General, who is primarily responsible for maintaining integrity within government-sponsored medical programs (Medicare and Medicaid) by providing oversight over these programs. OIG provides both preventive and corrective measures (via investigations and audits) to ensure that people employed in health care facilities or businesses do not break the law. This could mean that someone committed Medicaid/Medicare fraud, has lost their medical license, or abused patients.
OIG creates an "exclusion list" in order to identify individuals that have been excluded from participation in federal healthcare programs due to illegal acts. OIG screening is simply ensuring that you are checking the "exclusion list" on a monthly basis for either an individual or a vendor who is going to be provided services for a healthcare facility prior to hiring them and continuing to check this list every month for your current employees.
If a person is on the exclusion list, they cannot al(low) to participate in any federally funded health care programs. An OIG screening is essentially an ongoing comprehensive background check that prevents bad actors from being able to interact with patients; protects health care facilities from incurring significant fines/guidelines due to inadvertent background checks; and also serves to provide healthcare providers with the best possible candidates for providing quality care.
Learning about the CMS Open Payments program
Next, let’s discuss the medications and treatments your physician prescribes you – have you ever questioned whether your doctor prescribes you the best possible pill for your health (i.e., if your doctor states that this is the best option for your health), or is he/she just prescribing it to you because the drug company provided the physician with a complimentary vacation or consulting fees? The CMS Open Payments program addresses this very concern.
CMS (i.e., the Centers for Medicare/Medicaid Services) developed a national transparency rule known as the CMS Open Payments program to prevent providers from having conflicts of interest. Specifically, the program requires manufacturers of pharmaceutical products or medical devices to report publicly all monetary or in-kind payments to physicians or teaching hospitals.
For example, it includes all payments made for travel, meals, speaking engagements, or research grants. Combined together, this payment information from all manufacturers is submitted by the manufacturers to a publicly searchable database online. By shining a light onto these financial relationships between physicians and manufacturers, the CM’Open Payments program ensures that the medical decisions are made solely for the benefit of the patient, and not due to some hidden financial or non-financial relationship between the Manufacturer and the physician.
Together, We're Making Healthcare A Better Experience
When you look at the OIG Screening process and the CMS Open Payments program at first glance, they may seem like just another bunch of paperwork for a hospital's human resource department or compliance department. In fact, these two programs are powerful weapons in keeping average people safe.
OIG Screening helps to keep bad people out of hospitals so only people who are qualified will give you medical care. CMS Open Payments provides an insight into how the medical industry operates, giving patients and providers confidence that their medical care is not being compromised by "back door" money.
It's not the way you think about it. By using OIG Screening processes strictly and supporting the openness of the CMS Open Payments database, the health care industry is helping to ensure that your safety, health and confidence are always top priority in this business.
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