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HHS Finalizes ACO Waivers

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

On October 29, the Centers for Medicare & Medicaid Services (CMS) published a final rule finalizing waivers from certain healthcare-related fraud laws for certain financial arrangements involving accountable care organizations (ACOs) under the Medicare Shared Savings Program (MSSP). The interim rule, issued in November 2011 and extended in 2014, had been set to expire November 2, 2015.

The rule permits ACO participants to avoid violating the physician self-referral law, the Federal anti-kickback statute, and the civil monetary penalties (CMP) law provision relating to beneficiary inducements when they establish relationships within the ACO structure with other participants, including physicians and hospitals.

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