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ACO Fraud Waiver to Expire November 2; OMB Reviewing New Final Rule

Posted in Accountable Care Organizations, Affordable Care Act, Fraud and Abuse, Home Healthcare, Hospitals and Institutions, Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

In November 2011, the Centers for Medicare & Medicaid Services (CMS), along with the HHS Office of Inspector General, published an interim final rule regarding waivers from certain healthcare-related fraud laws for certain financial arrangements involving accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). CMS issued a continuation notice in the fall of 2014, but that continuation is set to expire November 2, 2015.

On September 9, the White House Office of Management and Budget announced that it is reviewing a final rule from CMS (CMS-1439-F; RIN 0938-AR30) that establishes waivers of the application of the Physician Self-Referral (Stark) Law, the federal Anti-Kickback Statute, and certain civil monetary penalties (CMP) law provisions for specified financial arrangements involving ACOs under the MSSP.

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