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Fraud and abuse laws might undermine value-based care

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In an NEJM Catalyst essay, Carmel Schachar, MPH, discusses whether fraud and abuse laws are suppressing value-based care. She concludes:

“To realize the true potential of value-based care, we must update the underlying assumptions in our fraud and abuse regulatory system. Broadly applying fraud and abuse regulations to all delivery models and only carving out limited exceptions makes no sense when we are trying to encourage innovative healthcare delivery structures. We should consider adopting the rule that so long as a healthcare delivery and finance structure is value-based care and not fee-for-service, it should be exempt from fraud and abuse laws, such as the Stark Law, that seek to penalize overutilization.”

To read her essay, please hit this link.


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