- Three years into the Medicare Shared Savings Program, accountable care organizations (ACOs) are getting a final rule that protects them from tripping certain fraud and abuse laws through their financial relationships.
- The rule finalizes an interim final rule that was estabilshed in 2011 with some minor adjustments but no major changes.
- The waivers protect Medicare ACOs from the Stark law regarding physician self-referrals, the anti-kickback statute and the civil monetary penalties law, all of which could have been implicated through the ACO payment and delivery model.
The finalized rule puts to rest any remaining concerns ACOs could be hampered by the fraud and abuse laws.
“The fact that they have finalized it and not felt compelled to narrow it in any fashion is a really important thing,” Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, told Modern Healthcare. “The federal fraud and abuse laws really do create a pretty significant barrier to a lot of the kinds of payment reform efforts that people are talking about.”
The HHS notes in the rule the waivers have been essential over the past few years to the Shared Savings Program, but adds it will watch to see if future adjustments become needed.