Vermont ACO faces allegations of fraud, faulty data

Colchester-based OneCare Vermont, the state's only ACO, faces allegations of fraud from a former employee who says the ACO's strategy was based on unreliable and flawed data, according to reports from VT Digger.

The U.S. Attorney's Office declined to intervene in the case, and records were made public Nov. 27. Four quick takeaways on the story, according to VT Digger:

1. The whistleblower is Robert Hoffman, the former manager of analytics for OneCare. Mr. Hoffman worked at OneCare from March to May 2018 before he was fired. He was formerly affiliated with Winston-Salem, N.C.-based Wake Forest Baptist's ACO and trained by Elliott Fisher, who developed the ACO model.

2. The complaint alleges that OneCare defrauded the state and federal government by relying on data systems that were "flawed" and "virtually useless." These data systems were used to set physician benchmarks and track progress toward those goals, which determines how much ACOs and their physicians are paid. Mr. Hoffman alleges he was fired days after presenting these concerns to his manager.

3. OneCare Vermont denies the allegations and said Mr. Hoffman only worked with the ACO for two months. The ACO said he brought up the data concerns "upon his departure." The organization said it conducted an internal investigation of the concerns presented by Mr. Hoffman and found them meritless.

4. Now that the case has been declined, Mr. Hoffman's private attorney may choose to prosecute it, or Mr. Hoffman may decide to file a civil lawsuit alleging he was fired in retaliation for voicing his concerns. State Auditor Doug Hoffer told VTDigger he would investigate allegations if Mr. Hoffman chooses not to move forward.

Read more here.

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