The federal government is hoping to emphasize care coordination in the healthcare industry. Recently, the Department of Health and Human Services’ Office of the Inspector General (OIG) has stated that it may soon overhaul anti-kickback regulations to help providers.
Under the statute, it is a criminal offense to knowingly and willfully offer, pay, solicit, or receive payment to induce or reward in return for referring patients or generating sales of any service or product payable by the Medicare or Medicaid programs. This can include cash, high-priced meals, free rent, vacations, and excessive compensation for consulting patients or providing other services.
New Care Coordination Efforts
The OIG requested input from providers on how the new care-coordination efforts could backfire regarding laws that prevent financial benefits traded for referrals. The OIG hopes to create new regulatory safety buffers to allow for specific exceptions to those same laws.
The OIG wrote in the Federal Register that they continue to consider protections against the harms caused by fraud and abuse by balancing flexibility for industry stakeholders to provide efficient, well-coordinated, and patient-centered care.
Improving Care Coordination
The OIG is interested in providing safe harbors for innovative technology to improve care coordination, as the current regulations include electronic health record, warranty, and transportation exceptions. These harbors currently prevent the government from trying to obtain civil monetary penalties against providers, suspending their participation in Medicare or finding liability under the False Claims Act. The OIG stated that Congress intends for these regulations to evolve over time and be in accordance with current business practices.
Provider Partnerships and the Value of Patient Care
Value-based care and provider partnerships have been the focus of the Centers for Medicare and Medicaid Services. One such effort, the Bundled Payments for Care Improvement model, is scheduled to begin in the fall season. Through this model, Medicare will provide a reimbursement for a patient’s care episode, but all providers must split this. However, under Accountable Care Organizations (ACO), they can share the savings or risk, which requires providers to develop close relationships with fellow providers. This could leave itself open to offering incentives that may fall within current federal anti-kickback regulations and develop issues for physicians and their practices.
Philadelphia Anti-Kickback Lawyers at Sidney L. Gold & Associates, P.C. Fight for Physicians’ Rights
If you are a physician who is unsure of the anti-kickback regulations or if you have another health care concern, the Philadelphia anti-kickback lawyers at Sidney L. Gold & Associates, P.C. can help. Contact us online or call us at 215-569-1999 for a free consultation today. Located in Philadelphia, we proudly serve clients from the surrounding areas, including Bucks County, Chester County, Delaware County, and Montgomery County.