The healthcare industry needs a lot of patients' trust and government recognition to run properly in the long term. Therefore, the open payments CMS is introduced in the healthcare sector to represent financial transactions publicly. This report records transactions made by companies that provide devices or medical equipment to physicians, doctors, nurses, or other recipients. This system of publicly reporting every transaction between the two main bodies of healthcare provides transparency and accountability. The CMS (Centers for Medicare & Medicaid ) is specifically used in the healthcare industry to build trust with patients. This approach shows ethical medical practices and is highly beneficial.
In this comprehensive blog post, we will explore the open payment CMS and why it is vital, specifically in the healthcare Industry. How does this process work to maintain integrity and accountability between healthcare bodies? So, patients' safety and health are not compromised. Additionally, we will explore what sanctions checks are and the types of sanctions check lists produced by different bodies. Why is it vital for healthcare organizations?
What Is CMS Open Payments?
The CMS payment system is designed to publicly represent the relationship between healthcare providers and vendors. This is a database in which all transactions are recorded and released online for everyone to see. Additionally, the CMS system supports vendor compliance and verifies the quality of services provided by the healthcare provider. The CMS Open Payments were first created as part of the Physician Payments Sunshine Act. Besides, they were aimed at bringing accountability to the healthcare industry.
This list provides the general public with a clear picture of the relationship between healthcare providers and vendors. Therefore, based on the payment made, anyone can determine the clear picture of the services offered by healthcare providers. This data also demonstrates the ethical value of healthcare professionals. It provides a transparent report on whether the services are affected by financial donations. Below is the table that explains the whole process of CMS Open Payments concisely for better understanding.
| Step | Who’s Involved | What Happens | Outcome |
| 1. Collect | Manufacturers & GPOs | Track payments/transfers to providers | Raw data gathered |
| 2. Submit | Vendors → CMS | Annual reports sent | CMS receives records |
| 3. Review | Providers | Check/dispute reported data | Errors corrected |
| 4. Validate | CMS | Verify accuracy & resolve disputes | Final dataset |
| 5. Publish | CMS → Public | Data released online | Public transparency |
| 6. Comply | Providers & Vendors | Maintain reporting & standards | Ongoing compliance |
What are Sanction Checks? Why It is Vital To Conduct It Thoroughly
Sanction checks are a systematic screening process to verify that healthcare providers, employees, or vendors appear on the exclusion sanctions list. This exclusion list is compiled by bodies such as OIG, SAM.gov, OFAC, and state Medicaid agencies. The sanction check is essential because it prevents the organization from unknowingly collaborating with individuals and entities that are banned by federal programs. The federal programs banned them based on factors like involvement in fraud or being linked to illegal activities. Thereby, conducting regular sanction check, healthcare organizations safeguard their integrity and ensure compliance with federal and state regulations. These also help in avoiding financial penalties and maintain trust with patients and regulators.
Types of Sanction Checks Every Healthcare Organization Needs
Many bodies prepare the list of defaulters so they can conduct sanction checks based on it.
1. OIG LEIE Check
- Screens individuals/entities excluded from Medicare & Medicaid.
- Maintained by the Office of Inspector General (OIG).
2. SAM / EPLS Check
- Verifies federal debarments.
- Ensures no contracts with entities barred from federal programs.
3. State Medicaid Exclusion Check
- Identifies providers banned at the state level.
- Protects against local compliance risks.
4. OFAC Sanctions Check
- Confirms compliance with national security & anti-terrorism laws.
- Screens against the SDN list and embargo violations.
5. State Medical/Nursing Board License Check
- Validates professional licenses.
- Flags suspensions, disciplinary actions, or inactive licenses.
Why Using Automated Systems is Beneficial During The Process
Choosing the automated system to run the sanction check for you instead of doing it manually. Or, advancing the fast check for CMS open payments is far more convenient to do online than to do it manually. At first, it’s quick and takes very little time, and the chances of human error are also minimal. The automated system performs a thorough check and verification for each entity, ensuring nothing is left behind.
Therefore, the quickest and most efficient way to conduct thorough verification and check the correct listing in the CMS system is automation. Whether the vendors correctly list the payment made by the healthcare organization. It’s all easy and error-free with automation.
Wrapping It Up!
The Open Payments CMS is a vital core for every patient, ensuring their health and access to healthcare providers. The list clearly stated the relationship between a healthcare organization and its vendor, and no services are influenced by donations. It’s a thorough list made public every year that includes every payment from the provided lunch to the given vacation. The list of all transactions provides transparency and accuracy.
It’s essential to sanction check the list once the vendors update it, and with automation, every transaction is clearly recorded and checked, ensuring nothing is missed. Therefore, integrating an automation system into your organisation is essential, and Venops is one of the best service providers for this.