AHA rejects ACO fraud and abuse waiver rules

Like other organizations who have called caution to the accountable care organizations (ACO) proposed rules from the Centers for Medicare & Medicaid Services (CMS), the American Hospital Association (AHA) was disappointed with the proposal, encouraging CMS to clarify fraud and abuse waiver rules under Medicare's Shared Savings Program, it said in a news brief last week.

The American Hospital Association, which represents 5,000 hospitals and health systems, supports the concept of ACOs but has long championed eliminating fraud and abuse rules that prevent the care coordination, according to the association.

"The Agencies' proposal will provide little practical value to hospitals and others interested in pursuing participation in the ACO Program or integration activities similar to an ACO," AHA stated in a June 2 letter to CMS and the Office of Inspector General.

The letter continues, "The AHA urges the Secretary to use the full scope of the combined authority granted by Congress under the Patient Protection and Affordable Care Act to issue waivers to enable Medicare providers and suppliers to offer the benefits of clinically integrated care to Medicare patients as participants in an ACO or through other clinically integrated organizations providing accountable care. Specific to the ACO Program, we urge that an 'ACO Waiver' be created covering the formation and operation of an ACO."

Comments for CMS' proposed ACO rules regarding fraud and abuse waivers close today.

To learn more:
- read the AHA letter (.pdf)
- check out the AHA News Now brief