The Stark Law Some federal statutes address fraud in government health care programs, and many of these laws vary considerably (Krause 2004). Some of these laws specifically target health care fraud. Example of the laws that the government direct at inappropriate health care activities includes the “Medicare and Medicaid Anti-Kickback Statute and Ethics in Patient Referrals Act (EPRA).” In 1989, Congress enacted the Ethics in Patient Referrals Act. Commonly known as Stark law, Congress named it in honor of Rep. Pete Stark, a Democrat from California, and original sponsor of the bill (Sprague 2004). This law places limitations on self-referrals by physicians and prohibits physicians from referring patients to organizations in which they have vested interest for “designated health services" (DHS) for which Medicare or Medicaid may pay the bill (Staman 2010). In other words, the basic application of the Stark law forbids “physicians from referring Medicare and Medicaid patients” to hospitals, facilities, or other health care entities in which they have a financial interest (Choudhry, Choudhry, and Brennan 2005, 364). The Stark law also prohibits a medical doctor from referring Medicare and Medicaid patients to hospitals or health care entities in which his or her immediate family member has a financial relationship. In accordance with the law, self-referrals are unethical practices that involve a physicians’ referral of patients to entities in which they have a financial interest. A financial interest may arise from owning a part of or having investment in the entity. A financial interest may also occur when a physician has a “structured compensation arrangement” with a health care facility or entity (O’Sullivan 2007). ... ... middle of paper ... ...he civil False Claims Act against Medicare providers in federal courts: A content analysis based on agency theory. PhD diss., The George Washington University. Kusserow, Richard P. 1997. The Medicare Medicaid antikickback statute and the safe harbor regulations - what's next? Health Matrix: Journal of Law and Medicine 2, no. 1 (Spring): 49- (22 p). Kvale, Steinar and Svend Brinkmann. 2009. Interviews: Learning the craft of qualitative research interviewing. 2nd ed. Thousand Oaks, CA: Sage. Lagnado, Lucette. 2000a. Columbia/HCA to pay the U.S. $745 million. Wall Street Journal. May 19. Lagnado, Lucette. 2000b. HCA Unit’s Guilty pleas resolve largest Medicare criminal probe. Wall Street Journal, December 15. Lahman, Larry D. 2005. Bad mule: A primer on the Federal False Claims Act. The Oklahoma Bar Journal 76, no.12 (April): 901-907.
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.
In America’s time there have been many great men who have spent their lives creating this great country. Men such as George Washington, John Adams, and Thomas Jefferson fit these roles. They are deemed America’s “founding fathers” and laid the support for the most powerful country in history. However, one more man deserves his name to be etched into this list. His name was John Marshall, who decided case after case during his role as Chief Justice that has left an everlasting mark on today’s judiciary, and even society itself. Through Cases such as Marbury v. Madison (1803) and McCulloch v. Maryland (1819) he established the Judicial Branch as an independent power. One case in particular, named Gibbons v. Ogden (1824), displayed his intuitive ability to maintain a balance of power, suppress rising sectionalism, and unite the states under the Federal Government.
Healthcare ethics is defined as a system of moral principles that guide healthcare workers in making choices regarding medical care. At its core lies our attitudes regarding our personal rights and obligations we have to others. When an unprecedented situation comes into play, we rely on medical ethics to help determine an outcome that would be the best case scenario for all involved. In order to appropriately review this case study, we must first identify the key stakeholders, the ethical principles, policy implications at the federal, state, and local levels, financial implications, and a viable resolution for the situation.
One of the biggest contributors to health care costs that I have seen during my time in the healthcare industry is insurance fraud. One example of such fraud came about two months ago. I was taking a phone call from a provider that was upset that one of their claims had denied even though all of their previous claims had been paid. In researching with a partner plan it was determined that the claim denied because this medical provid...
Fraud is putting the wrong information or up codding the codes on the claim form. This can be done by the doctor, biller and coder, and the patient selling their insurance number to false company. The false company can bill the insurance company, for false information whether it is services, medication,
The Stark Law was first introduced as the Ethics in Patient Referrals Act of 1989 and amended in 1993; since then, the Stark Law has been modified and separated into three distinct phases of regulations. Several services fall under the Stark Law commonly referred to as designated health services (DHS), under these regulations by the Centers for Medicare and Medicaid, the Stark Law forbids a physician from referring patients to themselves or any health care organization of a family member. The Stark Law is intended to limit medical services ordered by a doctor, in efforts of controlling healthcare expenditures. The Stark Law was implemented to prohibit physicians from performing medical procedures that are not required, using financial motives
According to the Board of Ethics, when health care professionals’ judgments interfere with a patient’s wellbeing due their personal and/or financial considerations, it refers to as conflict of interest. We can use the “BioLabs” scenario as a perfect example to highlight some of the unethical actions of health care professionals. Dr. Smithfire’s suggestion to refer all patients to “BioLabs” in order to keep the business in the family clearly demonstrates an act of ethical egoism. Ethical egoism is best defined as selfish acts (Morrison, E. E., & Furlong, E. 2014, p. 7). Dr. Smithfires’ primary focus is to do what benefit him and his business. In addition Dr. Smithfires does not only violate the Board of Ethics, but also one of the principles
The purpose of this paper is to discuss how Chief Justice John Marshall affected the American Judicial System. The reader will therefore first find a brief biography of John Marshall. Then the paper will explain in detail the origins of the Judicial Power to subsequently...
A. A review of this public health law was evolved as a separate discipline when the promotion of health
Remy, Richard C., Gary E. Clayton, and John J. Patrick. "Supreme Court Cases." Civics Today. Columbus, Ohio: Glencoe, 2008. 796. Print.
The United States of America is one of the most powerful nation-states in the world today. The framers of the American Constitution spent a great deal of time and effort into making sure this power wasn’t too centralized in one aspect of the government. They created three branches of government to help maintain a checks and balance system. In this paper I will discuss these three branches, the legislative, the executive, and the judicial, for both the state and federal level.
Hall, Kermit L, eds. The Oxford guide to United States Supreme Court decisions New York: Oxford University Press, 1999.
Today’s society protects against discrimination through laws, which have been passed to protect minorities. The persons in a minority can be defined as “a group having little power or representation relative to other groups within a society” (The Free Dictionary). It is not ethical for any person to discriminate based on race or ethnicity in a medical situation, whether it takes place in the private settings of someone’s home or in a public hospital. Racial discrimination, in a medical setting, is not ethical on the grounds of legal statues, moral teachings, and social standings.
In the medical industry, the quality of demand always remains constant despite the changes in prices and quality of services being provided. There usually is need for a regulatory agency to keep an eye on the market forces in the business so as to ensure the patients are not exploited. There are several regulatory agencies in the healthcare sector and it at times can be overwhelming (Stange, K. 2014). The main regulatory agency is the government, but it has several other agencies under it. These regulatory agencies play a role in not only the medical industry but also in the health insurance coverage.
The significant impact Robert Dahl’s article, “Decision-Making in a Democracy: the Supreme Court as a National Policy-Maker” created for our thought on the Supreme Court it that it thoroughly paved the way towards exemplifying the relationship between public opinion and the United States Supreme Court. Dahl significantly was able to provide linkages between the Supreme Court and the environment that surrounds it in order for others to better understand the fundamental aspects that link the two together and explore possible reasoning and potential outcomes of the Court.