The Office of the Inspector General’s opined that when a Medicaid insurer provides financial incentives to network providers for increasing the number of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services, such incentives would not violate the Anti-Kickback Statute.
In the proposed arrangement, network providers who increase the number of EPSDT services they provide by 10 percent would receive a $1 incentive payment for each beneficiary who receives EPSDT services in 2019. Those who bump up the volume to 20 percent, earn a $2 incentive payment and for those reaching a 30 percent increase, $3 per enrollee.
As written in the opinion,
The Proposed Arrangement would increase the likelihood that Enrollees requiring EPSDT services actually would receive them. This increased utilization of EPSDT services is consistent with the State’s goal of assuring that children receive early detection and care to avert, diagnose, or treat health problems as early as possible.
According to Revcycle Intelligence, CMS and OIG have acknowledged the challenges of developing value-based purchasing and reimbursement models in the face of current healthcare fraud and abuse laws. Both agencies recently put out separate Requests for Information (RFIs) on how to change specific rules and regulations to align with value-based care delivery and payment.
The OIG solicited public comment in August about how best to address regulatory provisions that may act as barriers to coordinated care or value-based care.
According to Modern Healthcare, Athenahealth recently wrote a letter to the OIG in response to that request. In his letter, Greg Carey, Athenahealth’s director of government and regulatory affairs, asked the OIG and CMS to allow providers to exchange money for exchanging patient data.
Read more about the OIG opinion from Revcycle Intelligence
Read more about the Athenahealth story from Modern Healthcare