Arent Fox Partner Linda Baumann Comments on Medicare Fraud Enforcement, Payment Reforms and the Stark Law
Health Care partner Linda Baumann was recently quoted in an article in Bloomberg BNA’s Medicare Report on the amount of money that the Medicare program recoups through its fraud and abuse enforcement efforts.
The article “Medicare Gets Big Bang for Its Buck by Fighting Fraud” discusses a government report that estimates that Medicare saved $12.40 for every dollar invested in program integrity for fiscal years 2013 and 2014.
Linda noted that the $12.40 “seems higher than usual,” but pointed out that the higher return on investment (ROI) might have occurred because CMS apparently changed its methodology for calculating ROI in this report, e.g., by including an estimation of the impact of revoking a provider’s billing privileges.
Click here to read the full article.
Another article in Bloomberg BNA’s Health Care Fraud Report, on “Fraud and Abuse Laws Block Payment Reforms,” describes an American Hospital Association (AHA) report noting that the fraud and abuse laws, such as the Anti-Kickback Statute and the Stark Law, are preventing the health care industry from moving to new payment models designed to improve the quality of care provided.
The AHA has urged Congress to revise the laws to support the trend toward value-based payments. Linda pointed out that “it will be important for industry stakeholders to weigh in if they want Congress to address other problems with the Stark Law as well.”
She also pointed out that AHA’s recommendations could be very helpful in this regard since one of the new safe harbors to the Anti-Kickback Statute that AHA has proposed would preempt the Stark Law in connection with compensation relationships.
Click here to read the full article.
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