The Centers for Medicare & Medicaid Services (CMS) is requesting public comments on actual or perceived conflicts of interest that could arise when Medicare-approved accrediting organizations (AOs) also offer fee-based consulting services for Medicare-participating providers and suppliers.  Such services — which CMS points out are not currently prohibited by law or regulation — may include:

  • Assistance for clinical and non-clinical leaders in understanding AO and CMS standards for compliance
  • Review of facility standards, processes, policies and simulation of a real survey
  • Identification of and technical assistance to address areas needing improvement
  • Educational consultative services

While CMS observes that such services “may be useful for entities to learn to comply with the requirements and identify gaps in compliance,” CMS is concerned that “this dual function may undermine, or appear to undermine, the integrity of the accreditation programs and could erode the public trust in the safety of CMS-accredited providers and suppliers.”  For instance, CMS notes that there could be circumstances in which an AO accredits a client facility as in compliance with the Medicare regulations at the same time the AOs consultancy service generates revenue assisting that facility in passing the AO’s accreditation surveys.  While some AOs have told CMS that firewalls exist between the arms of their businesses, CMS questions whether such firewalls are sufficient to prevent conflicts of interest.

CMS therefore is inviting feedback on whether it should issue regulations to address actual, potential, or perceived conflicts of interest as part of the AO application and renewal process.  CMS requests comments on a series of questions pertaining to the types of consultative services provided by AOs to the facilities they accredit; the effects of such arrangements; the potential impact of CMS rulemaking restricting such activities; and related topics.  Comments will be accepted until February 20, 2019.