Progressive lawmakers call on CMS to cull companies with history of Medicare fraud from ACO REACH

Healthcare DIVE December 12, 2022
Rebecca Pifer

At least 10 organizations with records of healthcare fraud and abuse prior to 2021 participated in the direct contracting program last year despite CMS screening requirements, the letter said.

More than 20 progressive lawmakers are raising concerns about ACO REACH in a new letter to the CMS, arguing the model gives insurers with a history of defrauding Medicare another toehold in the program and asking regulators to eject those entities from the alternative payment model.

ACO REACH, slated to begin in January, is a redesign of the direct contracting model called the Global and Professional Direct Contracting Model. It’s meant to tie traditional payments in Medicare to value and improve care coordination. Direct contracting entities from the original model are...

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