Final Medicare ACO Fraud and Abuse, Antitrust, and Tax Guidances

Along with the Centers for Medicare and Medicaid Services (CMS)’ publication of its final rule for the Medicare Shared Savings Program Accountable Care Organizations (ACOs), a number of other federal agencies have also finalized their guidances related to ACOs.

First, CMS and the U.S. Department Health and Human Services Office of Inspector General have finalized their guidance about waivers for ACOS regarding prohibitions against fraud, abuse, and collusion among health care providers under the prohibition against Physician Self-Referrals (Stark law), civil monetary penalties for fraud and abuse, the federal anti-kickback statute, and prohibition against gainsharing among hospitals and physicians.

Link to Original Source

The U.S. Department of Justice and Federal Trade Commission also finalized their statement on antitrust laws as applied to ACOs.

Link to Original Source

Finally, the Internal Revenue Service updated its notice to tax-exempt organizations and whether participating in or becoming an ACO would comply with the requirement of a “charitable purpose.”

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This entry was posted in Health Care Reform, Health Care Reform: Accountable Care Organizations. Bookmark the permalink.

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