President Donald Trump may change the rules regarding kickbacks in the medical field. His administration called for public comment on the matter in August. The agency took in public comments about the issue through October 26, 2018. The comments include many calls for changing the current Anti-Kickback Statute.
Why change the rules? Those in favor of changes to antikickback rules point to a need to encourage coordinated care efforts. This group contends the rules, designed to thwart attempts to provide referrals or assist patients solely for financial gain as opposed to patient need, have made it difficult for physicians to work together to meet a patient’s medical needs.
A misstep could result in allegations of Anti-Kickback violations — allegations that can come with harsh repercussions including steep monetary fines.
When are the rules a problem? The federal Anti-Kickback rules apply to Medicare and Medicaid beneficiaries and deter the improper use of financial motivation when choosing a physician, hospital or medication.
The problem emerges when these rules collide with the ability to meet a patient’s needs. New York Times provides the example of a patient that receives a financial incentive for losing weight or a hospital that provides incentives to physicians for reducing hospital stays and readmission rates or other clinical goals.
The change, referred to as a “regulatory sprint to coordinated care,” will need to balance the benefits of increased collaboration with the risk of an increased risk of fraud. Since the call for comment from the administration, lobbyists have increased efforts to encourage change. Whether or not change will occur and, if so, what that change will entail is not yet known. As such, this is an important area of healthcare law to watch in coming months.