Open Payments penalties: what inaccurate Sunshine Act records cost

The Physician Payments Sunshine Act requires every applicable manufacturer and group purchasing organization to report each transfer of value it makes to a covered recipient, accurately, to CMS Open Payments. The word that carries the risk is accurately.

An inaccurate record is a failure to report

CMS treats a record with the wrong physician, NPI, amount, or payment category the same as a record that was never filed. There is no separate, lighter category for honest mistakes. An accuracy error and an omission sit in the same place in the penalty schedule.

The penalty schedule

The combined statutory maximum is near $1.66 million a year. The figures are inflation adjusted, so they rise over time.

Why the cap is easier to reach than it looks

Each inaccurate record is a distinct violation. A single mis-attributed physician is a small number. Thousands of them across a year of reporting is a different picture. About 95.8% of the roughly 17 million records published each year are high-frequency, low-dollar general payments entered largely by field representatives into expense systems, where a typo, a duplicate, or an NPI mismatch never gets caught. Systematic error is the normal case, not the exception, and systematic error is what pushes penalties toward the cap.

The cheap control

Penalties attach at submission. The lowest-cost way to reduce the exposure is to correct errors before you file, by letting the physician confirm or dispute each payment first. That is what PayClear does: one verified ledger the physician owns, so what you report is what they confirm.