ACO Update: Federal Agencies Release Coordinated ACO Shared Savings Program Legal Issues


Today, several agencies simultaneously announced guidance for Accountable Care Organizations (ACOs). Today’s announcements include: (1) the proposed rule for the Medicare Shared Savings Program from the Centers for Medicare & Medicaid Services (CMS), (2) a notice and request for comments released jointly by CMS and the Department of Health and Human Service’s Office of Inspector General (OIG) regarding the fraud and abuse waiver authorities, (3) joint guidance from the Department of Justice (DOJ) and Federal Trade Commission (FTC) on related antitrust issues and (4) a notice and solicitation of comments from the Internal Revenue Service (IRS) related to tax-exempt organizations. The Shared Savings Program will begin operating on January 1, 2012.

CMS released its much anticipated new proposed rule, which can be found at This 400-plus page proposed rule provides incentives to health care providers and is designed to bridge the gap in the current “fragmented” health care system to bring high quality, low cost care to patients. In addition, CMS and OIG issued a joint notice related to waivers of the federal physician self-referral law, the anti-kickback statute, and the civil monetary penalty law related to the Medicare Shared Savings Program. The CMS and OIG joint notice and related comment period are available online at (see alert below for link). Both sets of rules will be published in the Federal Register on April 7, 2011 and the agencies will accept comments until June 6, 2011.

Please see full alert below for more information and links.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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