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The stark law
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Stark began as a way to combat the abuse of doctors referring patients to clinics for tests in which they had a financial interest. Today it primarily deals with the hospital level and has seen compliance gained through the use of qui-tam lawsuits brought by non-governmental relators. Subpart A of this section will lay out the creation of Stark, the initial statute that created it and the many implementation phases and alterations it has gone through in its twenty-five plus year history. Subpart B will lay out some basic definitions that are necessary to understand the various elements of Stark violation. And Section C will give an introduction to the brief history of the SRDP.
A. Stark Law: A Brief History
Stark was originally enacted
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Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.
Violations of Stark can come at a hefty price. The statute provides for the following sanctions on claims submitted for DHS in violation of Stark: (1) denial of payment; (2) requiring refund of funds received; (3) civil penalties of $15,000 per service if the violation is knowing; and (4) exclusion from Medicare or Medicaid programs where a physician or entity knowingly enters into an improper cross-referral arrangement or scheme in order to skirt the self-referral
Anti-Kickback Statute prohibits anyone knowingly or willfully offering, paying or soliciting or receiving remuneration, directly or indirectly; in cash or kind; in exchange for; patient referrals or furnishing or arranging a good or service for a Federal healthcare program including Medicare or Medicaid. Stark would also apply to Hanlester as well but Stark was not enacted until after the Hanlester case. Stark is strict liability, does not require the knowingly/willfully element, and is not prosecuted criminally.
Different countries have been known to deal with crime in different ways, some believe that we (Americans) should deal with criminals in a more serious and physical manner. In the article “Rough Justice A Caning in Singapore Stirs Up a Fierce Debate About Crime and Punishment” by Alejandro Reyes, it talks about how we should have more severe and physical punishment inside and outside of the U.S. After a teenage boy vandalizes a car in singapore. While in the editorial “Time to Assert American Values,” the writer attempts to persuade us and into thinking that the teenage boy, Michael Fey should not have been caned after vandalizing a car. After carefully analyzing the two texts, the reader realizes that the article “Rough Justice” has the
This paper will examine the privacy rules of the Health Insurance Portability and Accountability Act (HIPAA) of 1996
Danny Thiemann Mrs. Fleetwood English I-C 13 April 2014 Separate but not equal Does the name Jim Crow ring a bell? Neither singer nor actor, but actually the name for the Separate but Equal (Jim Crow) Laws of the 1900s. Separate but Equal Laws stated that businesses and public places had to have separate, but equal, facilities for minorities and Caucasian people. Unfortunately, they usually have different levels of maintenance or quality.
In December 2011, Texas Health and Human Services Commission (HHSC) received federal approval of a Medicaid Section 1115(a) Demonstration Waiver, entitled “Texas Healthcare Transformation and Quality Improvement Program,” for the period starting with December 12, 2011 through September 20, 2016. The main objective of the 1115 Waiver is to improve access to and quality of health care by expanding Medicaid managed care programs and promoting health care delivery system reforms while containing cost growth. Specifically, the Waiver created two new pools of funding—Uncompensated Care (UC) and Delivery System Redesign and Innovation Payment (DSRIP) pools—by redirecting funds that were available under the old Upper Payment Limit (UPL) payment methodology. DSRIP funding is used to offer financial incentives to health care providers that develop and implement projects aimed at improving how care is delivered to low-income populations. Specifically, the providers (often referred to as the “performing providers” or “performers”) propose and execute projects like programs, strategies, and investments designed to enhance access to health care, quality of health care, cost-effectiveness of services, and health of the patients and families served.
The current health care reimbursement system in the United State is not cost effective, and politicians, along with insurance companies, are searching for a new reimbursement model. A new health care arrangement, value based health care, seems to be gaining momentum with help from the biggest piece of health care legislation within the last decade; the Affordable Care Act is pushing the health care system to adopt this arrangement. However, the community of health care providers is attempting to slow the momentum of the value based health care, because they wish to maintain their autonomy under the current fee-for-service reimbursement system (FFS).
Pozgar, G.D. (2012). Legal Aspects of Health Care Administration. United States of America: Jones and Bartlett Learning, LLC.
The concept of liberty stems from the system of natural law. It is highly dependent on the belief in natural law, in regards to three different aspects. First, the foundation of both concepts. The natural law has been influential in many ways, therefore concepts can be developed or derived from such a system. Secondly, the ideas found in liberty are similar to those found in the natural law in regards to the law being controlled by an entity. Finally, for protection against arbitrary offense to ensure a state of equality. This concept depends on natural law by representing similar principles on infringement of rights. Ultimately, liberty can be seen as a concept adapted from the system of natural law in order to keep the same principles and
Barton, P.L. (2010). Understanding the U.S. health services system. (4th ed). Chicago, IL: Health Administration Press.
hite collar crime and public corruption have a direct impact on the American taxpayer; it is a myth that such crimes are victimless. The United States is struggling to create a health care system that meets the public’s ever changing needs at a reasonable cost. In this chapter, we illustrate the magnitude of health care fraud and how it impacts the taxpayer and eldercare. You are encouraged to report suspected cases. Reading these cases, you will notice how well individuals are rewarded when they stand up against outlandish creed.
Health care policy targets the organization, financing, and delivery of health care services. The reason for targeting these areas is for the licensing of health care professionals and facilities, to make sure there is protection of patients’ private health information, and there are measures of quality care, mistakes, malpractice, and efforts to control of health care cost (Acuff, 2010). There are several stages that one must take when creating a policy (see figure 1). The figure below shows the critical steps in the policy process. First, the problem must be identified, once the problem is identified potential policy solutions must be formulated, then the policy is adopted, and then implemented. After the policy is in place, an evaluation of the policy has to take place (This Nation, 2013).
The rule of law as formulated by Raz adds little to a modern democracy as it could apply to both democratic and non-democratic states. The substantive rule of law is unworkable in a system such as exists in the United Kingdom, where the legislature is legally sovereign. Indeed, as both versions of the rule of law have been and could be ignored by the legislature, it is pointless to take the rule of law seriously as a feature of the United Kingdom’s constitution.
Firstly in this report, I will be giving the different definitions of rule of law by different philosophers; secondly, I will be applying the rule of law to the English Legal system and thirdly I will be explaining separation of powers with a focus on the impartial judiciary. Finally, I will be using cases to support every detailed point given.
Hans Kelsen was an Austrian-American legal philosopher born on the 11th October 1881 in the Czech Republic and he passed away on the 20th April 1973 in the USA. He contributed to the drafting of the Austrian Constitution and developed the ‘pure theory of law’ which he first introduced in Chief Problems of the Doctrine of International Law (1911) and further expanded on it in General Theory of Law and State (1945). Kelsen’s work was influenced by Kantian philosophy which has inspired his quest for a ‘pure’ theory. The pure theory of law is theoretically free of any external influence and its major element is the norm, the most important one being the Grundnorm. The latter is influenced by historical facts and the aim of this research is to investigate Mauritian jurisprudence with respect to the normative science of Kelsen.
Should the aim of law be primarily focused on the protection of individual liberty or, instead, the normative goals aimed at the good of the society? The question of law and morality is difficult mainly because it needs to be addressed with current social conditions that exist, the morals and values that the particular society has. In general, the laws in any society should not only be focused on regulations, but it should also protect individual’s liberty. Devlin debate was based on deciding whether law should enforce morality. He debated about what the law ought to be and whether morality should be enforced by law to form a good society. Furthermore, John Stewart Mill did not write specifically on law and morality. His argument constituted mainly on the anti-enforcers side of law and morality because he believed in individual liberty. John Stuart Mill's assertion that the only justification for limiting one person's liberty is to prevent harm to another