Physician Financial Violations

Authors Note: This paper is being submitted on the 18th of March 2013 for the winter semester of Medical Law and Ethics section 05.

As healthcare cost, rapidly increase, healthcare professionals are finding innovative ways to contain cost. Occasionally, the healthcare organization may find themselves entombed in an ethical decision and find it difficult to take the appropriate action. In this paper, I will analyze the case study of Dr. S. and Dr. V.; and deliberate how the actions of Dr. S. and Dr. V. violated the Stark Law.

Physician and pain clinic owner Paramjit Singh Ajrawat, of Potomac, Maryland has been ordered to

Failure to satisfy the safe harbor does not mean that the ASC joint venture is necessarily illegal, but rather that it may be subject to scrutiny and prosecution. It is important to recognize that many ASCs with physician investors do not meet the safe Ambulatory surgery centers: While there is no immunity for “substantial compliance” (i.e., operating as close to the safe harbor as reasonable and practical), it is widely believed that ASC joint ventures that are appropriately structured and operated should have reasonably low risk under the Anti-kickback Statute, even if they do not come squarely within the safe harbor. This view is based, in part, on the only federal court case4 that analyzes the application of the Anti-kickback Statute to joint ventures. That court concluded that a physician’s ownership interest in a health care provider does not violate the Anti-kickback Statute so long as: n the return on investment is based on each physician’s ownership interest and not their referrals, n eligibility to invest does not depend on an agreement to refer, n the size of the investment is not based on referrals, and n physicians who do not refer are not required or pressured to

The Roaring Fork Valley Physicians, IPA, Inc., a Corporation adopted the unfair method of competition by determining fixing price agreement for the healthcare services provided by the doctors who are the members of

Considering the provisions of the Stark law, it is clear that Congress enacted the law to curb the self-referrals that were prevalent among medical practitioners due to the sprawling specialty hospitals and health facilities (Choudhry, Choudhry, and Brennan 2005). Furthermore, Congress saw the need to prevent a physician’s referral decision that is dependent on a selfish, financial gain. The idea was to preclude “overutilization” of certain health care facilities that may arise from objectionable referrals and the resultant increase in health care cost (Staman 2010).

In this paper we will define what the Stark law is, its purpose and benefit to the health care industry and some major points of how it has evolved over the years. The Stark law was originally enacted in order to prevent physicians or physician groups from abusing their self-referral programs. Since its conception, it has evolved into three separate provisions which will be discussed in detail later on. Finally, we will give a couple of examples of how the Stark law has affected some of the local physician groups and hospitals in my area.

The Center for Medicaid and Medicare Services has to be very careful in their reimbursement. They need to make sure the patient comes first in every situation. Patients also should have a say in their care. This is why the Physician Self-Referral Law or Stark Law was put into place.

Another example of unethical preferential treatment occurs when a person who is a donor to the hospital and receives access to care and amenities that are not accessible to the general population. At our facility, high dollar donors become members of the Sister Theodore Marie Society, an association titled after one of the founding sisters of our organization. Members of the Sister Theodore Marie Society are to be located

The Stark Law was created to address the government’s concern that health care decision making could and have been influenced unduly by a profit motive. It was determined, in my opinion, that if physicians have a financial incentive to refer to an institution that they have a financial interest in, this relationship could have an affect on utilization, patient choice, and competition. Traditionally, physicians and healthcare providers generate reimbursement based upon the quantity of services and procedures performed and evidence through the billing process. Unfortunately the minority section of less than ethical providers began to realize that without regulatory oversight, a great deal of money could be made by the creation of vertically integrated business models. By allowing this avenue for additional reimbursement, physicians could begin to order testing and procedures that may have not been ordered without the

Financial interest is an ownership interest, investment interest, or compensation arrangement, this could mean that a doctor is renting an office space at a hospital for a much cheaper price than others pay for the same space so that the doctor will refer patients to the hospital. These referrals are considered a “false claim” under the False Claims Act when reimbursements are received. With all the laws within The Stark Law it would be wise to consult a medical lawyer for legal advice as to better understand all the ramifications of mistakenly violating this

The date of service should never be change. In order for the insurance to pay (if they accept to do it), billing should re-submit the claim with the information about that office visit. Medicare usually has a retroactive effective date for Part B premiums, which can be deducted from the lump sum of the SSDI. In some cases, then there may be Medicaid eligibility for a period of time and again, any services obtained during that time could be paid by Medicaid. If Nancy takes a chance and change the date and this action is made, it can lead to an investigation under Medicare Fraud. Medicare claims must be filed no later than 12 months after the date when the services were provided. If a claim isn't filed within this time limit, Medicare can't

In FY 2014, the Department of Justice (DOJ) opened 924 new criminal health care fraud

The treatment of conflicts of interest and other ethical dilemmas that may arise in investment decisions.

With no ethics come dishonesty, disloyalty, fraudulence, and a host of other bad qualities. These qualities are total opposite of what one would need to possess if they were handling any form of business in the healthcare field, particularly in the finance department. When working with funds it is important to keep morals and ethics extremely high because when no one is looking is really when you’re being tested. Sometimes, humans tend to let financial issues burden them down to the point of giving up. If a person going through a tough time in life was to have access to a large amount of money, it would be imperative that this individual