HCFA: Clarifies Anti-Kickback Exemption For Managed Care
"A federal committee agreed to expand the exemptions under which Medicare and Medicaid managed-care plans are protected from prosecution under health care antikickback laws," the Wall Street Journal reports. The new "'safe harbor' plan would exempt [HMOs] and other managed care plans that receive fixed payments from the government." In addition, some plans that receive fee-for-service payments from the government would also be exempt from the antikickback legislation, which was designed to stop physicians "from giving or receiving financial incentives to steer patients to specific specialists or hospitals." According to one government official, the new "proposal essentially substitutes financial incentives for criminal penalties." The Journal notes that "[s]ince the plans get a fixed payment regardless of the number of services for each patient, there is no incentive for them to provide unnecessary services."
The new proposal will cover Medicare and Medicaid managed care plans, Defense Department health plans, and "some employer-sponsored managed care plans containing Medicare patients." The final rule will be drafted within three months by the Department of Health and Human Services' inspector general, but will take effect on an interim basis as soon as it is published in the Federal Register. The committee that drafted the new regulation was "composed primarily of health care trade-group leaders"; the panel was assembled "about six months ago to implement a provision of the 1996 health care law that called for expanding the safe-harbor protections" (Sharpe, 1/23).