October 26, 2018
Office of Inspector General,
Department of Health and Human Services
330 Independence Avenue, S.W., Room 5513
Washington, D.C. 20201
Re: OIG-0803-N, Request for Information Regarding the Anti-Kickback Statute and Beneficiary Inducement Civil Monetary Penalty
Dear Ms. Edwards,
The Medical Group Management Association (MGMA) is pleased to submit the following responses to the Office of Inspector General’s (OIG) Request for Information (RFI) on ways to address regulatory provisions under the Anti-Kickback Statute (AKS) and beneficiary inducement provision of the Civil Monetary Penalty (CMP) law that act as barriers to value-based care initiatives. We commend OIG for recognizing the need to modernize existing laws to reflect a more coordinated approach to care delivery and for seeking stakeholder feedback on how this can be done.
MGMA is the premier association for professionals who lead medical practices. Since 1926, through data, people, insights, and advocacy, MGMA empowers medical group practices to innovate and create meaningful change in healthcare. With a membership of more than 40,000 medical practice administrators, executives, and leaders, MGMA represents more than 12,500 organizations of all sizes, types, structures and specialties that deliver almost half of the healthcare in the United States.
MGMA recognizes that the OIG has the difficult task of implementing laws like the AKS and CMP that were drafted in a fee-for-service environment to protect against overutilization in a system based on volume. As reimbursement approaches continue to change over time and move toward alternative payment models (APMs) that pay for value, fraud and abuse laws and their implementing regulations have attempted to keep pace through modifications. Unfortunately, piecemeal modifications have resulted in an exceedingly complex fraud and abuse framework that introduces uncertainty and risk into any novel payment arrangement not explicitly protected by a waiver or other exception authority.
October 26, 2018