CMS finalizes fraud and abuse waivers for Medicare ACOs

The Centers for Medicare & Medicaid Services and Department of Health and Human Services Office of Inspector General today finalized waivers from fraud and abuse rules for Accountable Care Organizations participating in the Medicare Shared Savings Program. As urged by AHA, the final rule maintains key provisions of the 2011 interim final rule, which waived the application of the physician self-referral, federal anti-kickback statute and certain civil monetary penalty law provisions to specified arrangements involving ACOs in the program. The rule no longer waives the application of the CMP law provision relating to “gainsharing” arrangements, citing recent legislation clarifying that the prohibition only applies to medically unnecessary services. The final rule takes effect upon publication in tomorrow’s Federal Register.