Is gainsharing illegal? CMS cites clash between antifraud laws and value-based purchasing
Abstract: In gainsharing, participants share in cost savings or increased profits resulting from the efforts or actions of the provider receiving payment. But some federal regulations intended to fight health care fraud may have the unintended effect of impeding some of these incentive compensation arrangements. This article discusses several antifraud laws, including the Stark Law. According to the Centers for Medicare and Medicaid Services (CMS), the Stark Law “presents a particularly difficult obstacle to structuring effective programs that do not run afoul of the fraud and abuse laws.” The CMS suggests that waivers of some of these antifraud laws may be on the way. A sidebar explains that the Department of Health and Human Services has previously waived some fraud and abuse laws.