A Case for How ACOs Can Help Prevent Fraud, Waste, and Abuse
In an article published in Health Affairs Forefront, the authors describe how accountable care organizations (ACOs) helped identify widespread waste, fraud, and patient harm tied to Medicare’s payment system—in this case, for skin substitutes, a market that has skyrocketed significantly since 2019. As reported by The New York Times, certain manufacturers of skin substitutes (and some clinicians) have targeted vulnerable patients, including those who are living at home with dementia and end-stage renal disease, with high-cost, low-evidence wound care treatments that may cause harm. The authors of the Health Affairs Forefront piece argue that while ACOs are uniquely positioned to detect and report inappropriate spending, they remain financially vulnerable when fraud occurs beyond their control.
The authors call for CMS to finalize proposed payment reforms for 2026 and strengthen protections so ACOs caring for complex patients are not penalized for misuse they cannot prevent.