As with any compensation arrangement between providers and health plans involving federal healthcare programs, parties to a pay-for-performance arrangement need to be mindful of possible fraud and abuse, according to Kathryn A. Roe, of Neal, Gerber & Eisenberg LLP in Chicago.
Chicago - As with any compensation arrangement between providers and health plans involving federal healthcare programs, parties to a pay-for-performance arrangement need to be mindful of possible fraud and abuse, according to Kathryn A. Roe, of Neal, Gerber & Eisenberg LLP in Chicago.
"That means asking whether the contemplated arrangement implicates the federal anti-kickback or Stark laws or their state counterparts, and if so, whether there is an available safe harbor or exception," Roe says.
Interference issues. Another consideration might be claims that pay-for-performance results in plan interference with the patient-provider relationship. "That was a common concern in the '90s with the rise of plan utilization management and other similar programs," Roe says. "Health plans responded by adding the managed care contracts provider acknowledgments of their ultimate responsibility for care rendered to patients. Such clauses could have equal application to pay-for-performance arrangements."
- Tracey Walker
Breaking Down Health Plans, HSAs, AI With Paul Fronstin of EBRI
November 19th 2024Featured in this latest episode of Tuning In to the C-Suite podcast is Paul Fronstin, director of health benefits research at EBRI, who shed light on the evolving landscape of health benefits with editors of Managed Healthcare Executive.
Listen
HIV + Hepatitis Institute Welcomes RFK, Talks Importance of Ending the HIV Epidemic
February 13th 2025The group released a statement today expressing that they are eager to work with Robert F. Kennedy Jr. to eradicate HIV when steps into his role as the Secretary of Health and Human Services.
Read More
In this latest episode of Tuning In to the C-Suite podcast, Briana Contreras, an editor with MHE had the pleasure of meeting Loren McCaghy, director of consulting, health and consumer engagement and product insight at Accenture, to discuss the organization's latest report on U.S. consumers switching healthcare providers and insurance payers.
Listen