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The Fraud and Abuse Waiver for ACO Patient Incentives
Identify the federal law or laws that would be waived by the specific waiver on which the ACO and its participant intend to rely. Explain what is prohibited by that law or laws, and explain how the proposal could violate that law or laws in the absence of a waiver.
Summarize the requirements that must be met to qualify for the specific Waiver
Analyze whether the proposal meet all of the requirements for the specific waiver. State the arguments if any for concluding that the proposal meet all of those requirements, as well as the arguments if any for concluding that the proposal does not meet them. Be sure to state your conclusion and explain the basis for it.
As a matter of policy, explain whether you think that the requirements for that specific waiver should be changed by the secretary HHS. Specifically, should the secretary amend the requirements for that specific waiver to balance the goal of beneficiary complaince with care Management programs against the risk that ACOs could use extravagant incentives to steer beneficiaries? Be sure to state your conclusion and explain your reasoning for amending or not amending those requirements.
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