Lexology July 5, 2024
Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program got good news from The Centers for Medicare and Medicaid Services (CMS) related to widespread fraud involving urinary catheters that is estimated to involve as much as US$3 Billion in false claims. CMS has announced that it will hold ACOs harmless against the fraud by excluding the fraudulent claims from shared savings calculations.
The National Association of ACOs identified the issue to CMS because it raised concerns for ACOs which stood to lose millions of dollars. ACOs receive payments for certain savings with respect to Medicare Fee-for-Service (FFS) claims associated with the ACO’s beneficiaries, if the ACOs meet quality performance standards and demonstrate savings against a benchmark of expected...
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