CMS considers penalties, limits for providers steering patients toward ACA plans over Medicare, Medicaid

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CMS is considering new rules to stop healthcare providers who are seeking higher reimbursements from steering patients toward Affordable Care Act individual health plans over Medicare or Medicaid.

The health agency sent warning letters to Medicare-enrolled dialysis centers detailing its plans and issued a request for public comment on the topic. CMS is considering rules like monetary penalties on providers who delay individuals from enrolling in Medicare and cause eligible patients to receive enrollment penalties. The health agency said it may limit or bar healthcare providers' premium payments for ACA plans by healthcare providers as well as, in addition to changing Medicare and Medicaid provider enrollment rules. 

"We are concerned about reports that some organizations may be engaging in enrollment activities that put their profit margins ahead of their patients' needs," CMS Acting Administrator Andy Slavitt said. "These actions can limit benefits for those who need them, potentially result in greater costs to patients, and ultimately increase the cost of Marketplace coverage for everyone."

Health insurers like UnitedHealthcare, Anthem and Aetna raised concerns over third-party payments in the past months. For instance, UnitedHealthcare filed a suit against American Renal Associates alleging the Beverly, Mass.-based dialysis chain engaged in a "fraudulent and illegal scheme" to maximize its own profits. During an Aug. 2 conference call with investors, Aetna said third-party payers pushing patients toward the individual market influence an unhealthy pool of customers in its individual exchange plans, Reuters reported. 

More articles about payer issues:
3 thoughts from Marketplace CEO Kevin Counihan on Aetna withdrawal
Since ACA launch, 72% of California's uninsured now covered
Alabama eyes BP oil spill settlement for Medicaid funds

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