Hospitals called on HHS to relax anti-kickback rules that could affect alternative pay models, saying payments between providers in the models shouldn't violate the regulations.
Health Management Associates allegedly billed government healthcare programs for inpatient services that should have been billed as outpatient or observation, paid physicians for patient referrals and submitted inflated claims for ER facility fees.
California's insurance commissioner accused pharmaceutical giant AbbVie of illegally plying doctors with cash, gifts and services to prescribe Humira, tainting their relationship with patients and driving up insurance costs.
The CMS has received more than 300 suggestions on how it can reduce the burden of anti-kickback laws on providers, ranging from revising what is considered a referral to giving providers protection for unintentional violations.
HHS' Office of Inspector General is following in the CMS' footsteps to determine what legal protections it can provide to encourage providers to pursue value-based care arrangements.
HHS Secretary Alex Azar promised a conservative audience that his agency would put out new guidance on the Stark law and HIPAA as well as overhaul Medicare billing structures to drive down government costs.
Providers and a top HHS official Tuesday urged Congress to loosen the Stark law's restrictions. The move to value-based care models could be undermined if the 30-year-old law isn't changed.
The CMS has issued a request for information to review how it can reduce the burden around the controversial Stark law. Providers claim the law has slowed the move to value-based care.
Some providers believe HHS Secretary Alex Azar will ease provider self-referral restrictions that they say inhibit physicians and hospitals from building accountable care organizations.
Erie, Pa.-based UPMC Hamot and Medicor Associates agreed to pay the government $20.75 million to settle claims that they formed a kickback scheme that delivered unnecessary care.
CMS Administrator Seema Verma revealed the agency will convene a group to review the Stark law and how it's impeding providers' move to value-based care.
Last year, U.S. Deputy Attorney General Sally Quillian Yates warned top healthcare executives they would be held personally accountable for false Medicare and Medicaid claims and illegal physician relationships. She was serious.