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
Conversations With Perry and Friends: Paul Fronstin, Ph.D.
May 9th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. In this episode, his guest is Paul Fronstin, Ph.D., director of health benefits research at the Employee Benefit Research Institute.
Listen
FDA Lifts Safety Restrictions on CAR T Therapies After Reviewing Real-World Data
July 2nd 2025FDA officials have determined that information regarding the risks for six CAR T-cell therapies can be communicated through product labeling, which includes a boxed warning for the risks of cytokine release syndrome and neurological toxicities.
Read More
Conversations With Perry and Friends
April 14th 2025Perry Cohen, Pharm.D., a longtime member of the Managed Healthcare Executive editorial advisory board, is host of the Conversations with Perry and Friends podcast. His guest this episode is John Baackes, the former CEO of L.A. Care Health Plan.
Listen