• CMS and OIG Issue Final Rule on ACO Waivers
  • November 6, 2015 | Authors: Mark R. Fitzgerald; Christina A. Hughes
  • Law Firm: Powers Pyles Sutter & Verville, PC - Washington Office
  • As part of the Patient Protection and Affordable Care Act’s establishment of the Medicare Shared Savings Program (MSSP), the Centers for Medicare and Medicaid Services (CMS) and the Department of Health and Human Services Office of the Inspector General (OIG), developed waivers of the federal fraud and abuse laws for accountable care organizations (ACOs). On November 2, 2011, CMS and OIG jointly issued an interim final rule describing the waivers and their application and limitations.1 The waivers cover both the federal anti-kickback statute (under the OIG’s jurisdiction)and the Stark physician self-referral law (under CMS’s jurisdiction). Under the interim final rule, CMS and OIG established five new waivers from physician self-referral (i.e., Stark law), kickback, gainsharing, and beneficiary inducement prohibitions for ACOs engaged in certain activities.