ACO Fraud & Abuse Waivers

By: Robert D. Belfort
– Executive Insight

In an extraordinary effort to provide accountable care organizations (ACOs) with flexibility to establish innovative arrangements among hospitals, physicians and patients, the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services Office of Inspector General (OIG) have issued waivers that suspend the application of the Stark Law, the Anti-Kickback Statute and other fraud and abuse laws to ACOs participating in the Medicare Shared Savings Program (SSP).

The waivers rightfully have been heralded as a boon to ACO development. But ACOs and their participants should not mistake the waivers as a free pass from Medicare program integrity enforcement. In fact, not only are ACOs required to satisfy substantial conditions to take advantage of the waivers, they are also subject to unique compliance obligations not imposed on other healthcare organizations.



pursuant to New York DR 2-101(f)

© 2022 Manatt, Phelps & Phillips, LLP.

All rights reserved