AJMC April 23, 2025
Christina Mattina

Key Takeaways

  • ACOs are focusing on identifying and addressing anomalous billing, such as for catheters and skin substitutes, to prevent fraud and protect shared savings.
  • Collaboration with payers, regulators, and other ACOs is crucial for timely fraud detection and intervention, emphasizing the importance of data analytics.
  • ACOs are advocating for legislative support and CMS collaboration to address fraud challenges, aligning with the Trump administration’s focus on efficiency and waste reduction.

Accountable care organizations (ACOs) are increasingly playing the role of data sleuths as they identify and report trends of anomalous billing in hopes of salvaging their shared savings. This mission dovetails with that of CMS, which under the new administration plans to prioritize rooting out fraud, waste, and...

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Topics: ACO (Accountable Care), CMS, Govt Agencies, Insurance, Medicare, Payment Models, Primary care, Provider, Value Based
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