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More than 20 progressive lawmakers are raising concerns about ACO REACH in a new letter to the CMS, arguing the model gives insurers with a history of defrauding Medicare another toehold in the program and asking regulators to eject those entities from the alternative payment model.
ACO REACH, slated to begin in January, is a redesign of the direct contracting model called the Global and Professional Direct Contracting Model. It’s meant to tie traditional payments in Medicare to value and improve care coordination. Direct contracting entities from the original model are allowed to enroll as ACOs in REACH provided they meet the new requirements, and the majority are expected to stay on as the program swells from 99 participants in 2022 to as many as 202 currently planned in 2023.
At least 10 of those organizations have records of healthcare fraud, abuse and lawbreaking prior to 2021, but might still be allowed to transition into ACO REACH, according to the letter.