Several healthcare advocacy organizations — and at least two government agencies — are supporting efforts that make it easier for medical providers to share information about or refer patients to their partners.
But watchdogs say the efforts to give providers more control over quality through value-based payment initiatives may actually create new avenues for fraud or corruption.
“We have no objection to changes in rules, regulations, or laws that make healthcare provision more efficient and provide savings for taxpayers — provided that they do not undo the protections that are in place to catch those bad actors that are out there working the system,” Robert Patten, CEO of Taxpayers Against Fraud, told Bloomberg News.
Last year, both the Office of Inspector General and the Centers for Medicare & Medicaid Services said they were looking into how existing regulations, including the Stark Act and the Anti-Kickback Statute, could be barriers to coordinated care encouraged by value-based approaches.
Currently, those rules prohibit payment for recommending products or services to patients covered by Medicare or Medicaid. This results in hospitals typically shying away from recommending specific partners, including skilled nursing facilities, even if they have demonstrated an ability to quality care for specific diagnoses.
Both laws aim to keep the personal financial considerations of providers from influencing their medical decisions.
Some critics worry that pulling back restrictions on financial relationships will lead to more industry consolidation. The trend has already created significant pressure on skilled nursing providers, who are often called upon to share data and build new skill sets to stay in hospitals’ preferred partner networks.
