The Open Payments Database, 2024: $11.96B in Industry Payments

Source file

open-payments-2024.csv

Published

Not reported

Retrieved

Not reported

Snapshot

sha256:40503e91634060c703f1f23ff4c2a207b94bf6c1fe0c34467940450875f757e7

Re-check

open-payments-2024.csv

Data as of

2024

What Open Payments actually is

Every year, the federal government publishes a near-complete ledger of the financial relationships between the companies that make drugs and medical devices and the clinicians who prescribe and implant them. It exists because of the Physician Payments Sunshine Act, a 2010 provision of the Affordable Care Act (§6002) that requires manufacturers to report almost every payment or transfer of value they give to a physician, a nurse practitioner or physician assistant, or a teaching hospital. The Centers for Medicare & Medicaid Services collects those reports and releases them as the Open Payments database — a public record many people still know by the name ProPublica gave its companion tool, “Dollars for Docs.”

The 2024 release is enormous: 16,146,544 individual records totalling $11.96B. It arrives in three files. The general file is the one most people mean by “payments to doctors” — meals, travel, speaking fees, consulting, gifts, and royalties — and it holds 15,385,047 records worth $3.31B. The research file records funding for clinical studies, $8.49B, most of which flows to institutions rather than to an individual clinician. The ownership file lists physician ownership and investment interests, $147.8M across 4,591 records. This study focuses on the general file, because that is where the everyday relationships — and the public questions — sit.

One point matters before any number: a disclosed payment is not, by itself, evidence of anything wrong. Royalties on a patented implant, consulting on a trial design, an honorarium for a lecture, and a sandwich at a lunch-and-learn are all legal and ordinary. The Sunshine Act was written to make these ties visible, not to forbid them. Fonteum reports the disclosed totals exactly as CMS published them and makes no claim about the conduct of any clinician or company. Every figure on this page is an aggregate; no individual physician is named, ranked, or profiled.

A $11.96B year, in three files

The general file alone — $3.31B — reached 979,136 distinct clinicians from 1,763 reporting manufacturers. Almost every record carries a National Provider Identifier: 15,336,988 of 15,385,047 general records (99.7%) name the recipient by NPI, which is what makes the file joinable to the rest of the provider graph. Teaching hospitals appear too — 34,391 general records went to a hospital rather than an individual.

The single largest disclosed general-payment record in 2024 was $91.1M — one transaction. That one number is a preview of the study’s central finding: in Open Payments, the dollars and the records live in completely different places.

Two open-payments economies

Sort the general file by what kind of payment each record is, and a stark split appears. Royalty and license payments are just 0.1% of all general-payment records — 15,053 of 15,385,047 — yet they carry 25.6% of the dollars, $846.8M. Food and beverage is the mirror image: 91.7% of all records — 14,101,484 separate meals — but only 12.4% of the dollars. The three richest categories together — royalty / license, speaking & faculty, and consulting — are 2.9% of records but 63.3% of the money ($2.1B).

General (non-research) payments only, CMS program year 2024. “% of $” is each category’s share of the $3.31B general total. Full short labels shown; the CSV carries the exact CMS category strings.

The specialties that collect the most

Orthopaedic Surgery receives more general-payment money than any other specialty — $381.4M in 2024, 3× the next specialty (Internal Medicine, $113.4M). The ranking is device economics made visible. Specialties that implant patented hardware — orthopaedics, spine surgery, neurosurgery — earn large royalty and consulting payments tied to the products they help design and use. High-volume cognitive specialties like internal medicine appear high on the list too, but mostly through a very large number of small meals rather than a few big checks.

Top 20 recipient specialties by general-payment dollars, 2024. Specialty is CMS’s published taxonomy, shortened for display.

Who pays the most

BioNTech SE disclosed the most general-payment money in 2024 — $180.6M across just 164 records, a sign that its total is driven by a few very large payments rather than broad reach. The top of the list mixes the two industry archetypes: pharmaceutical companies whose totals come from millions of meals and speaker programs, and device makers whose totals come from royalties and consulting tied to implants. Both patterns are legal and routine; the file simply makes their scale legible.

Top 20 manufacturers by general-payment dollars, 2024. Names are as reported to CMS (legal-entity spellings vary).

Where the recipients are

General-payment dollars track where clinicians are, with CA leading at $334.5M. Read this as a count, not a per-capita rate: large states with more physicians naturally see more payments. The geography is most useful as a denominator for local reporting — pair a state’s total here with its provider counts to ask whether industry money is unusually concentrated relative to the size of its medical workforce.

Top 59 recipient states by general-payment dollars, 2024. The CSV carries all states and territories.

The biggest single checks

The largest individual general-payment records show where the concentration comes from. They are dominated by two categories: acquisition payments (a company buying out a clinician-held interest or patent) and royalty payments on widely used drugs and devices. We list each record by category, manufacturer, recipient specialty, and state — never by name. These are reported transactions, not allegations.

Largest 10 single general-payment records, 2024. Recipient identity withheld — aggregate-only by policy. Download the full category/manufacturer/specialty/state breakdown as CSV.

Why research dollars look bigger than general dollars

A reader skimming the totals will notice something odd: the research file ($8.49B) is larger than the general file ($3.31B). That does not mean individual clinicians personally received more research money. Most research payments are made to a teaching hospital, academic medical center, or research site that runs a clinical trial — the funds cover study costs, not personal compensation — with a named physician recorded as the principal investigator. The general file is the one that maps to personal transfers of value, which is why this study leads with it. We surface the research and ownership totals for completeness and to keep the $11.96B headline honest.

Methodology & reproducible SQL

Every figure is a direct aggregation over the cms_open_payments table — the operational projection of the CMS Open Payments 2024 General, Research, and Ownership disclosure files (16,146,544 rows; RLS Pattern B, public read). Because the table is far too large to aggregate inside a single web request, the counts were re-derived through six Postgres materialized views (one headline row plus by-nature, by-specialty, by-manufacturer, by-state, and largest-record views) and pinned in the committed snapshot dated 2026-07-14. The page and CSV read that same snapshot. No unpaginated row select is issued against the 16,146,544-row table. Method version open-payments/v1. The headline numbers reproduce with:

-- Headline: records + dollars by file
SELECT record_type,
  count(*)                          AS records,
  round(sum(total_amount_usd))      AS total_usd
FROM cms_open_payments
WHERE program_year = 2024
GROUP BY record_type;

-- General payments by nature of payment
SELECT nature_of_payment,
  count(*)                          AS payments,
  round(sum(total_amount_usd))      AS total_usd
FROM cms_open_payments
WHERE record_type = 'general' AND program_year = 2024
GROUP BY nature_of_payment
ORDER BY total_usd DESC;

-- General payments by recipient specialty (top 20)
SELECT recipient_specialty,
  count(*)                          AS payments,
  round(sum(total_amount_usd))      AS total_usd
FROM cms_open_payments
WHERE record_type = 'general' AND program_year = 2024
  AND recipient_specialty IS NOT NULL
GROUP BY recipient_specialty
ORDER BY total_usd DESC
LIMIT 20;

-- Distinct recipients + reporting manufacturers (general)
SELECT count(DISTINCT recipient_npi)     AS distinct_clinicians,
       count(DISTINCT manufacturer_name) AS reporting_manufacturers
FROM cms_open_payments
WHERE record_type = 'general' AND program_year = 2024;

A few decisions shape the counts. We scope every aggregate to program_year = 2024. “General payments” means record_type = 'general' — the file that maps to personal transfers of value — and percentage-of-dollars figures use the $3.31B general total as the denominator. Recipient specialty is CMS’s own taxonomy string, shortened for display but exported verbatim in the CSV. Manufacturer names are as reported, so legal-entity spelling varies across rows. Read how every Fonteum figure is sourced on the sources page.

Limitations

• One program year. All figures are CMS program year 2024 (published 2026-01-23). They are a snapshot of one year, not a trend.
• Manufacturer-reported. Companies report the data; CMS publishes it after a dispute window. Disputed records are included as reported. A small share of records carry no NPI and a few amounts are corrected in later releases.
• Records, not people. Category and specialty totals count payment records. One clinician can appear in many records; this study does not de-duplicate the general file to a per-physician total.
• Research flows to institutions. The research total largely funds study sites, not individual clinicians; we keep it out of the per-clinician framing for that reason.
• Aggregate-only, no quality claim. Fonteum does not name, rank, or rate any clinician here, and industry payments are not a measure of a provider’s competence or the quality of care.

Frequently asked questions

Related research

• Who is enrolled in Medicare (PECOS) — the provider base these payments reach.
• OIG exclusion list patterns — the separate federal sanctions track.
• Hospital ownership & margins — the financial backdrop teaching hospitals operate in.
• Open Payments dataset page — field-level documentation, provenance, and downloads.
• NPI lookup — inspect an NPPES record and any PECOS or OIG rows that publish the same NPI.
• Sources & methodology index.

Sources

1. U.S. Centers for Medicare & Medicaid Services — Open Payments (program year 2024). openpaymentsdata.cms.gov
2. Physician Payments Sunshine Act — Affordable Care Act §6002; 42 CFR Part 403 Subpart I. ecfr.gov · 42 CFR 403 Subpart I
3. CMS — Open Payments data dictionary and methodology. cms.gov/open-payments
4. CMS Open Payments downloads (General, Research, Ownership CSVs). dataset downloads

Fonteum Research · Published 2026-06-12 · Re-derived 2026-07-14 · Reviewed by Jennifer Montecillo, MD, medical reviewer. Non-practicing medical reviewer. · Data source: CMS, public domain under 17 U.S.C. §105 · Published free under CC BY 4.0 · Method open-payments/v1.