Stark Law

Medicaid fraud comes in many forms. A provider who bills Medicaid for services that he or she does not provide is committing fraud. Overstating the level of care provided to patients and altering patient records to conceal the deception is fraud. Recipients also commit fraud by failing to report or misrepresenting income, household members, residence, or private health insurance. Facilities have also been known to commit Medicaid fraud through false billing. The Medicare and Medicaid fraud and abuse statute provides that an individual who knowingly and willfully offers, pays, solicits, or receives any remuneration in exchange for referring an individual for the furnishing of any item or service

Our healthcare system is in a state of constant change. Just as the industry was adapting to the demands of countless healthcare reforms, the fate of regulations like the Affordable Care Act (ACA) and others like it, dangle in the wind. As the country transitions to a newly appointed administration, there is an increasing level of uncertainty among industry leaders. Federal, state, and local mandates continue to drive the need to improve the quality, costs, and outcomes of care which add to an already overburdened and burnout system. These coupled with our highly secular society who is primarily focused on the treating and curing illness through advanced technology, medications, and procedures has resulted in a

When considering the American medical system, it is clear that the policy solutions for disparities occurring outside the clinical encounter

The American Health Care system needs to be constantly improved to keep up with the demands of America’s health care system. In order for the American Health Care system to improve policies must be constantly reviewed. Congress still plays a powerful role in public policy making (Morone, Litman, & Robins, 2008). A health care policy is put in place to reach a desired health outcome, which may have a meaningful effect on people. People in position of authority advocates for a new policy for the group they have special interest in helping. The Health care system is formed by the health care policy making process (Abood, 2007). There are public, institutional, and business policies related to health care developed by hospitals, accrediting organizations, or managed care organizations (Abood, 2007). A policy is implemented to improve the health among people in the United States. Some policies

The discharge of an employee in contravention of fundamental public policy, as expressed in a statute or constitutional provision, can serve as the basis for a tort action for wrongful discharge. (Gantt v. Sentry Insurance, supra, 1 Cal. 4th at pp. 1094-1097; see Rojo v. Kliger (1990) 52 Cal. 3d 65, 88-91 [276 Cal.Rptr. 130, 801 P.2d 373].) Accordingly, since section 2056 expresses a public policy to protect physicians and surgeons from retaliation for advocating medically appropriate health care, a wrongful [84 Cal. App. 4th 52] discharge action can be premised on a termination in violation of that public policy.

There are certain steps to developing a health care policy. The first is the action taken after a legal or judicial decision can often lead to the creation of a new health policy or program. This can stem from any legal action taken against a physician or insurance company by a patient or their family. The second step is to develop the regulation, guidelines, and implementation for the new program, as they have been described in the new law. Many believe that the new health polices should be form by policy experts, but the use of health care professional can serve as an asset in developing these polices.

Although the Stark law does not apply to ASCs, the federal Anti-kickback Statute does apply. The Anti-Kickback statute prohibits any person from “knowingly and willfully” providing any remuneration to induce referrals, or in exchange for referrals, of federal health care program patients or business.2 Accordingly, the Anti-kickback Statute applies to any physician-owned ASC that treats federal health care program patients (including Medicare and Medicaid), in that the potential return on investment, arguably, could be viewed as an inducement for physician investors to refer to the ASC. However, there is an ASC “safe harbor” under the Anti-kickback Statute, which protects various types of physician-owned ASCs as well as hospital/physician ASC

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

In 2010, through President Barrack Obama’s advocacy, the United States enacted the Patient Protection and Affordable Care Act (“PPACA”) in an effort to ensure that all Americans have access to health coverage. As part of the PPACA Congress directed the Secretary of the U.S. Department of Health and Human Services (“HHS”) to develop and implement a Medicare Self –Referral Disclosure Protocol. The SRDP is intended to foster the resolution of potential or actual violations of Stark. This Section will give an in depth look at disclosures prior to SRDP, its enactment and the important developments in its brief existence.

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.

Social Security Act Section 1877, known as the Physician Self-Referral law or “Stark Law” enacted first by Congress in 1989, and since amended several times over, prohibits physicians from making referrals for certain healthcare

Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation.

Laws are essential to healthcare because it helps protect anyone in healthcare. One of the laws is HIPPA known as Health Insurance Portability and Accountability Act, it is the most well-known medical law. This protects patients privacy about medical treatment and records. Not only this, but HIPPA goes beyond that protection, it also provides the ability to transfer and continue health insurance coverage when workers change or lose their jobs, reduces healthcare fraud and abuse, and mandates industry-wide standards for healthcare information on electric billing and other processes. The Stark law is one only those with the advanced understanding of healthcare administration and law may have heard of. Stark law is another way to safeguard against

Healthcare reforms including Obama Care, formally named the Patient Protection and Affordable Care Act greatly impacts physicians and nursing shortages. There are several provisions which could direct impact physicians and nurses through incentives for potential recruitment, grants, training and retention. Through potential initiatives, the act may indirect effects that may question or present new reimbursement alternatives and models of health care delivery options. Healthcare reforms will allow millions of additional working as well as no working Americans to obtain healthcare coverage and this

In the administration of medical services in the United States law and regulation now control much of professional life. (p. 586)