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

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

Premier commends the Centers for Medicare & Medicaid Services (CMS) for its swift action in proposing to address the concerns we have raised around recent significant, anomalous, and highly suspect (SAHS) billing activity in Medicare to ensure that accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) are held harmless. In a recent letter to CMS, Premier joined additional stakeholder groups in highlighting a staggering 20-fold increase in Medicare claims related to catheters over the past two years, which CMS is now actively investigating as suspected fraud. Premier applauds CMS for adopting our recommendation to exclude payments for the two catheter HCPCS codes from the 2023 performance year, protecting MSSP ACOs from unjust repercussions due to SAHS billing.

Premier looks forward to continued collaboration with CMS to develop a long-term solution that streamlines the process for MSSP ACOs to report suspected fraud and safeguards them from being unfairly penalized for billing that is outside of their control.