Physician Self Referral ( Stark ) Law

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

Dr. Harried is not doing ethical practice. His ordering based upon what the insurance will cover is unethical. His only interest to earn money. One year ago he stopped taking patient with one type of insurance because it was paying less than others. Dr. Harried took an oath to place the interest of the patient in advance of his own interest including his patient’s financial interest. Unfortunately, he is not keeping his oath promise.

Katz states, “the conviction that physicians should decide what is best for their patients, and, therefore, that the authority and power to do so should remain bested in them, continued to have deep hold on the practices of the medical profession “(214).

The client is referral to a particular medical professional depending on the clients need. Determining the most

Dr. V. and Dr. S. violated the Stark Law, initially, they did not violate the law when they decided to lease a nuclear camera. Although the Stark Law prohibits self-referrals for Medicare and Medicaid, there are exemptions; physicians may perform DHS services if they ordered the service. Under the assumption that Dr. V and Dr. S. ordered the services, they were not in violation of the Stark Law.

In the health care business, there are certain standards and laws that have been put in place to protect our patients and their personal health information. When a health care facility fails to protect their patient’s confidential information, the US Government may get involved and facilities may be forced to pay huge sums of money in fines, and risk damaging their reputation.

First is the privacy rule, which is meant to guard the confidentiality of all protected health information. This is defined as any information that includes the patient’s name or other identifiers, such as a birth date or medical record number. Protected health information can be data that is written, spoken, or in electronic form. The privacy rule came about because many healthcare workers have been far too willing to talk casually about their patients without thinking how this violates their confidentiality, The Final Rule modifies the Privacy Rule to extend direct liability for disclosures of PHI by business associates. However, the rule does not subject

The American Medical Association (AMA) published a Code of Ethics for Physicians that includes a list of certain principles physicians should follow in order to be good physicians, practicing in an ethical fashion. This list, which was first adopted in June of 1957 and revised as recently as June of 2001, demonstrates some principles that are not universally accepted to be critical to the ethical practice of a physician. In particular, all physicians do not completely believe the claim that “A physician shall support access to medical care for all people” (Principles of Medical Ethics). Theorist, H. Tristam Engelhardt believes that the lack of access to care for some may be unfortunate, but it is not unfair and that this access does not need to be mandated, nor does believing it should be make you an ethical physician. In fact, Engelhardt supremely believes that by providing access of care to all, you will hurt certain patients that already have access to care, negating your function as a physician practicing beneficence. Engelhardt would retract this statement from the Principles of Ethics. However, this belief of and drive to implement access of care to all is critical to one’s job as a physician and it goes against core values of physicians to claim otherwise. Theorists such as Tom Beauchamp and Norman Daniels would agree that the universal access to health care is a critical component of the values physicians hold.

After receiving the P&L Statement covering expansion, the administrative resident must develop and justify a new indirect cost allocation scheme for outpatient services. The scheme must be perceived as fair and promotes overall cost savings within the Medical Center.

The existing federal ethics in patient referrals law, which is known as the stalk law, is ineffective against physician self-referral arrangements (Centers for Medicare & Medicaid Services, 2013). The statutes in the stalk law prohibit physicians from referring patients for advanced diagnostic treatment such as pathology

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

The Physician Self-Referral Law or Stark Law is a law that was passed to limit financial gain by physicians or their families. The Stark Law was originally enacted in 1989 and only applied to physician referrals to laboratory services. It was not until 1993 and 1994 that Congress expanded the prohibition to ten additional designated health services. Congress also applied certain aspects of the law to the Medicaid program (Stark Law, 2013).

On an average, primary physician groups may see about four or five patients within an hour, probably about one patient every fifteen minutes. Because of increase productivity and cost restraints and pressures, this number could increase dramatically. This trend, unfortunately, will be matching the burden of physicians declining incomes and job market. A lessor number of physicians earn what physicians earned many years ago. Primary health has been affected more as compared to services rendered. Additionally, the shift to a bundled fee for performance from the fee for service reimbursement system for force solo practicing physicians and small group practices into forming or partnering into

Health care professionals are subject to a multitude of professional, legal, and ethical responsibilities which call for personal judgment to be utilized in such a manner as to protect clients as well as public wellness and interests. Overall considerations in handling such duties may be considered to be respect of a client’s autonomy, confidence, and recognition of obligations owed to all clients. While the aforementioned acts fall within the professional realm, there are also legal implications that guide care. Therefore, it can be said that ethical considerations occur in observation of legal responsibilities. Confidential information is perceived as private facts which are disclosed with the

“Professional integrity derives its substance from the fundamental goals or mission of the profession” (Wakin, 1996, para. 15). Meaning to say, individuals seek for a professional’s valued and ethical advice to which the professional holds their responsibility to maintain and exceeds the level of their expertise. For example, a general practitioner will treat a variety of patients, from all different walks of life with a plethora of different problems. It is their duty to diagnose and treat the patient to the best of their professional ability without prejudice. Another aspect of their duties is the principle of patient confidentiality. Medical professionals are legally bound to not divulge any information provided to them by their patients.