OIG Wants Input on Changes to Anti-kickback Statute and CMP

The U.S. Department of Health and Human Services Office of the Inspector General is looking for ways to encourage and incentivize coordinated care, without violating the Anti-kickback Statute and Civil Monetary Penalties Law. The CMP imposes penalties against those who offer or transfer remuneration to a Medicare or state healthcare program beneficiary to influence the beneficiary’s selection of a provider or supplier.

To that end, the government watchdog agency has issued a request for information that would help identify ways in which it might change or add new safe harbors to the antikickback statute, in order to foster arrangements designed to promote care coordination and advance the delivery of value-based care, while at the same time protecting against fraud and abuse.

There have been numerous efforts to create innovative models of care designed to improve coordination and outcomes through incentivized value-based arrangements. Those efforts have resulted in a push to make changes to existing patient self-referral laws, without losing the teeth needed to prevent fraud and abuse.

In its request, the OIG notes that it is “mindful of the impact of delivery system and payment reform on federal healthcare programs and the changing relationships between providers, suppliers and other entities in delivering higher quality, better coordinated care; enhancing value; and improving the overall health of patients.”

OIG said in its request that it is particularly interested in topics that include, but are not limited to:

  • The structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements designed to promote care coordination and value;
  • The need for new or revised safe harbors and exceptions to the definition of ‘‘remuneration’’ under the beneficiary inducements CMP to promote beneficial care coordination, patient engagement and value-based arrangements;
  • Terminology related to alternative payment models, value-based arrangements and care coordination.

The RFI asks for a broad range of information from stakeholders such as:

  • Potential arrangements that the industry is interested in pursuing, such as care coordination, value-based arrangements, alternative payment models, arrangements involving innovative technology, and other novel financial arrangements that may implicate the anti-kickback statute or beneficiary inducements CMP.
  • The types of incentives providers, suppliers, and others are interested in providing to beneficiaries, how providing such incentives would contribute to or improve quality of care, care coordination, and patient engagement, including adherence to care plans, and whether the types of providers, suppliers, or other entities that furnish the incentives matter from an effectiveness and program integrity perspective.
  • How relieving or eliminating beneficiary cost-sharing obligations might improve care delivery, enhance value-based arrangements, and promote quality of care.

Other related topics of interest include: healthcare fraud and abuse waivers, cybersecurity-related items and services, the ACO beneficiary incentive program, and telehealth.

The deadline to respond is Oct. 26.

The OIG request closely follows a solicitation for comments by the Centers for Medicare & Medicaid on potential changes to the Stark Law. CMS issued an RFI relating to the physician self-referral law in June and that comment period ended Aug. 24.

The Health Law Offices of Anthony C. Vitale represents healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others. If you have any questions contact us at 305-358-4500 or email us at info@vitalehealthlaw.com.

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