MGMA 2017 Annual Conference

As reimbursement models shift towards performance- or value-based, healthcare providers are left to struggle with self-referral and fraud and abuse rules still geared toward fee-for-service reimbursement. The Stark Law's current restrictions present challenges for physicians who are striving to change the way they deliver care to better fit with the incentives and goals of value-based reimbursement models. Regulatory agencies and False Claims Act qui tam relators have had increasing success in bringing enforcement actions based on the way doctors are compensated. Many of these enforcement actions have involved very technical theories of noncompliance. Strict liability standards for Stark Law violations coupled with the ambiguity associated in squaring a fee-for-service based law with value-based reimbursement makes this a worrying trend for providers and raises the stakes for compliance.