No VIP treatment: ACOs should not get waiver protection from the prohibition on beneficiary inducement

Accountable care organizations (ACO) require flexibility from the existing health care fraud and abuse framework. This flexibility includes a waiver from the prohibition on beneficiary inducement, affording ACOs significant freedoms to employ inducements in ways that other health care delivery models cannot.

This waiver was intended to give ACOs an additional mechanism to retain patients and boost participation in disease management and compliance programs. Improving patient compliance with health care directives is a crucial component of health care reform but at what cost? This note argues that ACOs should not be given a waiver from the prohibition on beneficiary inducement as the risks of distorting patient decision-making outweigh the benefits of affording ACOs more freedom. This note proposes that ACOs operate within the existing enumerated exceptions of the prohibition and offers supplemental strategies to address patient attrition and compliance within ACOs.

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