On August 10, 2026, the U.S. Department of Justice (DOJ) announced a pharmaceutical company that agreed to pay over $46 million to resolve criminal and civil allegations involving kickback schemes.
What is a Kickback?
The Centers for Medicare & Medicaid Services (CMS) defines a kickback as “the soliciting, offering, paying, or receiving of remuneration—in cash or in kind—to induce or in return for patient referrals, or for the generation of business involving any goods or services payable by a federal healthcare program.”
According to the DOJ press release, the pharmaceutical company paid for lavish meals, alcohol, and luxury resort stays to sway healthcare providers to prescribe one of their prescriptions. Subsequently, the organization was charged with conspiracy to violate the federal Anti-Kickback Statute.
This case highlights the importance of having effective compliance processes in place to identify and address potential conflicts of interest and other financial relationships that may raise regulatory concerns, including reviewing the Open PaymentTM Database.
What is the Open PaymentTM Database?
The Open PaymentTM Database was created by CMS to promote transparency and accountability in the healthcare system. The database contains information about physician payments that were reported by Entities such as the pharmaceutical company discussed above.
The payment data is updated annually and released by June 30. CMS also updates the information in January to reflect any resolutions or corrections.
For 2025, the Open PaymentTM Database reported a total of $14.67 billion across 7.07 million records. This is an increase of $920 million compared to the prior year.
Why Should Organizations Review Open Payments Data?
Organizations should have an annual process in place to review their physicians’ reported payments. This review could help identify potential Conflicts of Interest (COI), Anti-Kickback Statute concerns, Stark Law concerns, or reporting errors. There may be some payments that raise questions or warrant additional analysis.
If an organization or physician identifies any errors, the information should be disputed with the reporting entity.
Need Help Reviewing the Open Payments Data?
Does your organization need help completing this review? LW Consulting, Inc. (LWCI) currently assists clients with Open Payments reviews and can help your organization establish an effective review process.
Contact LWCI to schedule a conversation and learn how we can support your organization’s compliance efforts.
LW Consulting, Inc. (LWCI) offers a comprehensive range of services to assist your organization in maintaining compliance, identifying trends, providing education and training, or conducting documentation and coding audits. For more information, contact LWCI to connect with one of our experts!
| Sources: |
| Facts About Open Payments Data. Centers for Medicaid & Medicare Services. (n.d.). https://openpaymentsdata.cms.gov/summary |
| Health Care Fraud and Program Integrity – CMS. Centers for Medicare & Medicaid Services. (n.d.). https://www.cms.gov/files/document/healthcarefraudandpi072616pdf |
