Medicare Fraud Rules Eyed for Overhaul

WASHINGTON (CN) — Health and Human Services touted two Medicare law changes proposed Wednesday by the Trump administration, saying they will enable specialty clinicians to share data with a patient’s primary care physician, coordinating better care.

The changes are aimed at a prohibition against physician self-referral, more commonly known as the Stark Law, and the federal Anti-Kickback Statute, which forbids the exchange of valuables or money for federal program referrals.

When passed decades ago, the laws were meant to shield patients from fraud and abuse. Today, however, they are seen as an obstacle, preventing physician referrals or the donation of gifts that could benefit patients.

By changing the laws, the government says physicians can now do something as benign as providing patients with smart pillboxes, free of charge, to help patients keep track of their medication.

Another goal of the proposed changes is to improve follow-up care for patients as they are released from hospital care. The original rules forbade physicians and organizations from providing patients with additional services or technology after they were discharged, treating such contact as illegal enrichment.

“Our proposed rules would be an unprecedented opportunity for providers to work together to deliver the kind of high-value, coordinated care that patients deserve,” Health and Human Services Secretary Alex Azar said a statement. “Regulatory reform has been a key piece of President Trump’s agenda not just for faster innovation and economic growth, but also better, higher-value health care.”

The changes are expected to take months, while health care industry lawyers dissect nearly 800 pages of proposed regulations. Though geared at federal programs like Medicare and Medicaid, the rules are expected to bring changes across the health care system.

Azar’s release says some benefits of the proposed changes include better patient access to technology, as well as better access to cybersecurity for organizations. Through the proposed changes, health organizations could be gifted free software to each physician who refers a patient to a hospital.

The HHS’ Office of Inspector General, which oversees compliance with the Anti-Kickback Statute, is listed in the release as another organization involved in issuing the proposed changes. Acting Inspector General Joanne Chiedi said in statement Wednesday the office also was proposing strong safeguards to protect patients from bad actors, seeking to misuse the law’s new flexibility.

“Any patient can tell you how difficult it is to coordinate their own care,” she said. “This proposed rule would help patients to focus on their health, enable providers to better coordinate high-quality health care, and empower both to achieve improved health outcomes.”

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