“While the healthcare industry is evolving from fee-for-service to quality-based payment, the Stark Law (42 U.S.C. § 1395) and the Anti-Kickback Statute (42 U.S.C. § 1320a–7b) have remained stuck in the past. These two fraud and abuse laws have impeded the continued development and utilization of value-based arrangements that reward high quality health care and improved health outcomes. The Stark Law, for example, was created to combat the exchange of financial incentives in return for referring patients for designated health services (DHS) – an exchange that can incentivize the provision of unnecessary care under a fee-for-service payment system. However, with the healthcare industry’s recent shift toward value-based payments, overutilization is no longer the problem it used to be. The Stark Law and Anti-Kickback Statute are misaligned with the current health care industry payment landscape and as result have impeded forward progress toward value-based care.”
“On November 20, 2020, consistent with this Administration’s “Sprint to Coordinated Care,” the Centers for Medicare & Medicaid Services (CMS) and the HHS Office of the Inspector General (OIG) issued final regulations significantly overhauling the Stark Law and the Anti-Kickback Statute, and also issued one change to the Civil Monetary Penalty Law (CMPL) regulations, that broadly impact all parts of the health care industry. Generally effective January 19, 2021, these regulatory revisions recognize that the rules governing the health care payment landscape must change to allow providers and suppliers to more closely coordinate to achieve CMS’s triple aim goal of high-quality care, improved health outcomes, and…” Read the full article here.
Source: CMS Issues Sweeping Reform to Modernize the Stark Law: Part I – November 30, 2020. Crowell & Moring.