Orthopaedic surgeons commonly have relationships with companies that sell the devices used in the practice of orthopaedic surgery. These relationships create both opportunity and risk for both the surgeons and the companies.
These complexities are on display in a November 11, 2025 article in the Columbus Dispatch, the headline of which is presented here as it appeared in the newspaper without any judgement on the accuracy of the article or the appropriateness of the actions of either party.
I asked Claude.ai for some context regarding surgeon-company relationships. This is a bit long, but may be useful to some of our readers, especially those having or considering relationships with industry. The text below is directly from Claude; I've not verified its accuracy.
Legal and Regulatory Framework
Several federal laws govern financial relationships between physicians and medical device companies, particularly when those relationships may influence institutional purchasing decisions that affect Medicare and Medicaid patients:
The Anti-Kickback Statute
The Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)) is a criminal statute that prohibits knowingly and willfully offering, paying, soliciting, or receiving remuneration to induce or reward referrals of items or services reimbursable by federal healthcare programs. "Remuneration" includes anything of value and takes many forms beyond cash, including consulting fees, speaking honoraria, research grants, and travel expenses. Violations constitute a felony punishable by up to ten years imprisonment and $100,000 in fines per violation. The statute covers both payers and recipients of kickbacks, and importantly, requires proof of intent to induce referrals or business.
A critical aspect of the Anti-Kickback Statute is that even if one purpose of the payment is to influence referrals or purchasing decisions, the statute is violated—it need not be the only purpose. When a physician receives substantial payments from a device manufacturer and then influences institutional purchasing decisions in that manufacturer's favor, prosecutors may argue this creates an inference of improper intent.
The Physician Self-Referral Law (Stark Law)
The Physician Self-Referral Law (Stark Law, 42 U.S.C. § 1395nn) prohibits physicians from referring Medicare patients for designated health services to entities with which they have a financial relationship, unless an exception applies. While the Stark Law is more limited in scope than the Anti-Kickback Statute—applying only to physicians, only to Medicare, and only to "designated health services"—it operates as strict liability, requiring no proof of intent. Penalties include denial of payment, refund of monies received, civil monetary penalties up to $15,000 per service, and treble damages.
The False Claims Act
The False Claims Act permits the government to recover damages when false claims are submitted to federal healthcare programs. Critically, violations of the Anti-Kickback Statute or Stark Law can render submitted claims "false" for purposes of the False Claims Act, even without specific intent to defraud. This provision significantly amplifies enforcement, as whistleblowers can file qui tam suits and receive 15-30% of any recovery.
The Physician Payments Sunshine Act
The Physician Payments Sunshine Act (part of the Affordable Care Act) requires manufacturers of drugs, medical devices, and biologicals to report payments to physicians and teaching hospitals. These payments are disclosed in the Open Payments database, a searchable public resource maintained by the Centers for Medicare & Medicaid Services. This transparency mechanism allows patients, institutions, and regulators to examine financial relationships between industry and physicians.
Ethical Dimensions
The American Medical Association's Code of Medical Ethics addresses physician relationships with industry, emphasizing that such relationships must not compromise professional judgment or prioritize physician interests over patient welfare. The AMA specifically addresses medical device representatives, emphasizing that their presence and involvement should be subject to facility policies and should never substitute for appropriate physician training.
The American College of Physicians has articulated similar principles, noting that while industry partnerships can advance medical knowledge, they create opportunities for bias. ACP emphasizes that the distinguishing feature of true professionalism is "effacement of self-interest"—placing patient welfare above personal financial gain.
Academic medical centers have particular obligations because of their educational, research, and patient care missions. The Institute of Medicine (now National Academy of Medicine) issued comprehensive recommendations in its 2009 report "Conflict of Interest in Medical Research, Education, and Practice. The report called for academic medical centers to prohibit faculty from accepting items of material value from industry except in specified situations, to require written consulting contracts paid at fair market value, and to establish robust conflict of interest review committees.
Patient Welfare: The fundamental obligation of healthcare professionals is patient welfare. Financial conflicts risk prioritizing cost, physician convenience, or industry relationships over optimal patient outcomes.
Industry Relationships and Academic Medicine: Medical device development requires physician input—surgeons provide essential feedback on implant design, surgical techniques, and clinical applications. However, when physicians receive substantial payments and then influence institutional purchasing, the line between legitimate collaboration and improper inducement blurs.
Institutional and Systemic Implications
• Commonness of Industry Payments: Open Payments data reveals that physician-industry financial relationships are widespread. Between 2014 and 2018, over $8.7 billion was transferred from industry to physicians.
• Dual Roles and Conflicts: Physicians increasingly occupy dual roles—clinician and administrator—creating complex conflict landscapes. When a department chair who receives industry payments also controls purchasing, the conflict intensifies. Academic medical centers must carefully structure decision-making to insulate procurement from individual financial interests.
• Conflict Management: Effective conflict management requires not just policies but enforcement mechanisms, monitoring, and accountability. Institutions need conflict of interest committees with authority to review arrangements, require recusals, and impose consequences for violations.
• Transparency Gaps: While the Sunshine Act improved transparency, significant gaps remain. Patients rarely know about their physicians' industry relationships. Hospital boards and administrators may not fully understand the extent of conflicts within their institutions.
• Cultural Factors: Academic medicine has historically tolerated—even celebrated—industry relationships, viewing them as markers of expertise and influence. This culture can normalize conflicts and create pressure on junior faculty to develop similar relationships. Changing this culture requires leadership commitment, clear policies, and willingness to forgo lucrative arrangements when they create unmanageable conflicts.
Claude.ai's Recommendations and Best Practices
"Several recommendations emerge for academic medical centers:
• Strict Separation of Purchasing and Industry Relationships: Physicians with substantial industry financial relationships should be categorically excluded from institutional procurement decisions involving those companies. This separation should be absolute, not merely advisory. Procurement should be managed by committees that include physicians without conflicts, purchasing professionals, and patient representatives.
• Enhanced Conflict Screening: Institutions should proactively screen conflict of interest disclosures against procurement activities. When a physician with industry relationships is involved in decisions that could benefit those companies, automatic triggers should require review and potential recusal.
• Transparent Governance: Procurement decisions should be documented, including who participated, how decisions were made, and whether conflicts were identified and managed. Minutes should be retained and subject to audit.
• Accountability Mechanisms: Violations of recusal commitments should trigger serious consequences, potentially including suspension from administrative roles, financial penalties, or termination. Without accountability, policies lack teeth.
• Education and Culture Change: Institutions should provide regular training on conflicts of interest, emphasizing not just legal compliance but ethical obligations. Leaders should model appropriate behavior and create cultures where physicians feel empowered to decline problematic industry relationships.
• Patient and Public Engagement: Patients and the public should have input into conflict of interest policies. Patient representatives should serve on conflict of interest committees and procurement committees.
• Limitation of Industry Payments: Academic medical centers should consider limiting industry payments to faculty. Some institutions prohibit speaking fees and restrict consulting to narrow circumstances. While legitimate collaboration is valuable, broad consulting arrangements create pervasive conflicts.
• Use of Open Payments Data: Institutions should routinely query Open Payments to identify undisclosed relationships and verify accuracy of disclosures. Compliance programs should integrate Open Payments monitoring into routine audits.
Ultimately, trust in academic medicine depends on physicians and healthcare leaders acting with integrity, managing conflicts transparently, and prioritizing patient welfare above personal financial interests.
Food for thought
Common Yellowthroat
Union Bay Natural Area
2022
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Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
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The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).
Follow on facebook: https://www.facebook.com/shoulder.arthritis
Follow on LinkedIn: https://www.linkedin.com/in/rick-matsen-88b1a8133/
Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link)
The total shoulder arthroplasty (see this link)
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link)
Shoulder rehabilitation exercises (see this link).