The Secretary of Health and Human Services, in an unpublicized report, has responded to Congress’ request for options to amend the existing fraud and abuse laws. The report offers no legislative or regulatory proposals. Instead it provides observations on the effect of fraud and abuse laws, concluding that these laws can be an “impediment to robust, innovative programs that align providers by using financial incentives to achieve quality standards, generate cost savings, and reduce waste.” More specifically, the report calls out the physician self-referral law as a significant problem, saying that “the physician self-referral law presents a particularly difficult obstacle to structuring effective programs that do not run afoul of the fraud and abuse laws.” Last July, the AHA released and widely distributed a report responding to Congress’ call for recommendations with specific legislative proposals to tackle the barriers created by the physician self-referral and anti-kickback laws.