Statement on CMS Final Rule to Hold MSSP ACOs Harmless from Anomalous DME Billing

By Soumi Saha, Senior Vice President, Government Affairs, Premier Inc.

Premier applauds the Centers for Medicare & Medicaid Services (CMS) for taking decisive action to address the alarming surge in suspicious billing practices within Medicare. By finalizing a rule that shields accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) from the consequences of recent significant, anomalous, and highly suspect (SAHS) billing activity, CMS is demonstrating its commitment to protecting the integrity and sustainability of the program.

Premier, along with other key stakeholders, brought attention to a 20-fold increase in Medicare claims related to catheters over the past two years—a spike that CMS is now investigating as potential fraud. Premier is pleased that CMS has adopted our recommendation to exclude payments for the two catheter HCPCS codes from the 2023 performance year. Premier also strongly supports and urges CMS to finalize its proposal in the Calendar Year 2025 Medicare Physician Fee Schedule proposed rule that compliments this final rule by addressing SAHS activity in the future. These crucial steps ensure that MSSP ACOs are not unfairly penalized for billing irregularities beyond their control and will help minimize delay in shared distributions.

Premier calls on CMS to continue working with ACOs to improve the process for reporting suspected fraud, waste and abuse and to explore new opportunities to deepen its partnership in promoting high-quality and efficient patient care.