The Medicare Rights Center (Medicare Rights) appreciates the opportunity to comment on the Office of the Inspector General’s (OIG’s) Medicare and State Healthcare Programs: Fraud and Abuse; Revisions To Safe Harbors Under the Anti-Kickback Statute, And Civil Monetary Penalty Rules Regarding Beneficiary Inducements. Medicare Rights is a national, nonprofit organization that works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs, and public policy initiatives. Medicare Rights provides services and resources to three million people with Medicare, family caregivers, and professionals each year.

General Comments

Changes in the way Medicare providers deliver care are an important aspect of the switch to value-based care. The penalties for violating some current anti-kickback and self-referral laws and regulations can be severe, from criminal and civil monetary penalties (CMPs) to denial of participation in Medicare. It is possible that fear of these repercussions could potentially hamstring providers who seek innovative partnerships, incentives, or strategies to reduce costs and increase beneficiary engagement or adherence to treatment.

We are pleased the Office of the Inspector General (OIG) has included important consumer protections in the proposed provisions. Such protections can help to ensure that beneficiaries are not penalized through higher costs, underutilization, unnecessary care, or other circumstances that reduce the quality, accessibility,  convenience, transparency, or affordability of their care. OIG appropriately acknowledges the need for smart design, robust oversight, and strict enforcement of beneficiary protections to ensure both the program and the people who need it are safe. Ultimately, people with Medicare suffer when loopholes and poor incentives are permitted…