A New Fraud and Abuse Paradigm for ACOs: Blurring the Distinction Between Providers and Payers

By: Robert D. Belfort
– BNA Health Care Fraud Report

Congress has enacted a web of fraud and abuse laws designed to check the rapid growth in the cost of federal health care programs such as Medicare and Medicaid. These fraud and abuse laws are rooted in the policy concerns raised by the fee-for-service reimbursement system, which has been the predominant mechanism for compensating health care providers.

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