Cooperating for better care.

News & Views

HHS completes ACO waivers to avoid Stark law issues

Share this:


The U.S. Department of Health & Human Services has finally completed waivers for Medicare Accountable Care Organizations to help participants avoid running int0 the fraud and abuse laws that govern financial relationships among physicians and hospitals.

Modern Healthcare reports that “The new rule makes some tweaks but doesn’t significantly change waivers to the anti-kickback statute, the physician self-referral statute known as the Stark law and the civil monetary penalties law, which many in the industry viewed as potential barriers to the payment and delivery model. The CMS and HHS’s Office of Inspector General created the waivers with an interim final rule in 2011. ”

“The fact that they have finalized it and not felt compelled to narrow it in any fashion is a really important thing,” Harold Miller, CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, told the publication “The federal fraud and abuse laws really do create a pretty significant barrier to a lot of the kinds of payment reform efforts that people are talking about.”



“The problem becomes if you want hospitals and physicians working together without consolidating, technically, that can be illegal today, and this enables them to do it if they’re part of an ACO but not if they’re outside of an ACO,” Miller said of the waivers. “You’ve got kind of this big gap that exists.”

Contact Info

(617) 230-4965

Wellesley, Mass