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CMS & OIG Continue ACO Fraud and Abuse Waivers for Another Year

By Marisa E. Adelson on October 17, 2014
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On October 16, 2014, the Centers for Medicare & Medicaid Services (“CMS”) and the Office of the Inspector General (“OIG”) announced the continuation of the Accountable Care Organization (“ACO”) fraud and abuse waivers for an additional year. The Affordable Care Act (“ACA”) authorized creation of the Shared Savings Program to facilitate development of ACOs in Medicare. The ACA also allows for a waiver of certain fraud and abuse laws to provide ACOs greater flexibility in developing innovative models of care. CMS and the OIG published an interim final rule establishing waivers of the Federal self-referral law and anti-kickback statute and certain civil monetary penalty provisions for ACOs in the Shared Savings Program. This interim final rule extends the application of these waivers through November 2, 2015 unless a final waiver rule becomes effective at an earlier date. CMS explained that this extension will minimize legal uncertainty and business disruptions of ACOs. CMS also requested additional stakeholder input on the adequacy of the existing waivers.

Photo of Marisa E. Adelson Marisa E. Adelson

Marisa Adelson is an associate in Crowell & Moring’s San Francisco office, where she practices in the Health Care and Antitrust groups. In her health care practice, Marisa represents managed care payors and provides counseling on regulatory compliance. Marisa’s antitrust practice primarily involves…

Marisa Adelson is an associate in Crowell & Moring’s San Francisco office, where she practices in the Health Care and Antitrust groups. In her health care practice, Marisa represents managed care payors and provides counseling on regulatory compliance. Marisa’s antitrust practice primarily involves complex antitrust recovery litigation. Marisa has an active pro bono practice and currently represents a client from South Asia seeking asylum in the United States.

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  • Posted in:
    Health Care
  • Blog:
    Health Law
  • Organization:
    Crowell & Moring LLP
  • Article: View Original Source

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