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Reconsidering Health Care Fraud and Abuse Laws

Reconsidering Health Care Fraud and Abuse Laws Opinion EDITORIAL Carmel Shachar, JD, MPH; Gregory Curfman, MD When financial incentives influence physicians’ clinical Centers for Medicare & Medicaid Services adopted these in- decision-making, there may be cause for concern. Not all in- ducements in its Merit-Based Incentive Payment System, which ducements aimed at affecting the utilization of medical ser- adjusts physician reimbursement based on quality, cost, clini- cal practice improvement, and implementation of electronic vices, however, are ill-intentioned. At a time when medical spending is stressing the US health records. health care system, financial Outside the public payor system, physicians and health Related articles pages 1755 inducements aimed at en- care organizations have been unable to capitalize on value- and 1785 couraging cost controls or im- based health care in part because of the regulatory barriers proving outcomes should be supported. To more accurately blocking innovative uses of inducements. For example, a distinguish between public-minded vs detrimental financial hospital may want to establish a care coordination program inducements, the time has come to revisit the health care fraud for patients discharged to a skilled nursing facility. However, and abuse laws that regulate these inducements. any support or incentives to the facility could be considered The current regulatory http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Reconsidering Health Care Fraud and Abuse Laws

JAMA , Volume 324 (17) – Nov 3, 2020

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Publisher
American Medical Association
Copyright
Copyright 2020 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2020.19795
Publisher site
See Article on Publisher Site

Abstract

Opinion EDITORIAL Carmel Shachar, JD, MPH; Gregory Curfman, MD When financial incentives influence physicians’ clinical Centers for Medicare & Medicaid Services adopted these in- decision-making, there may be cause for concern. Not all in- ducements in its Merit-Based Incentive Payment System, which ducements aimed at affecting the utilization of medical ser- adjusts physician reimbursement based on quality, cost, clini- cal practice improvement, and implementation of electronic vices, however, are ill-intentioned. At a time when medical spending is stressing the US health records. health care system, financial Outside the public payor system, physicians and health Related articles pages 1755 inducements aimed at en- care organizations have been unable to capitalize on value- and 1785 couraging cost controls or im- based health care in part because of the regulatory barriers proving outcomes should be supported. To more accurately blocking innovative uses of inducements. For example, a distinguish between public-minded vs detrimental financial hospital may want to establish a care coordination program inducements, the time has come to revisit the health care fraud for patients discharged to a skilled nursing facility. However, and abuse laws that regulate these inducements. any support or incentives to the facility could be considered The current regulatory

Journal

JAMAAmerican Medical Association

Published: Nov 3, 2020

References