Stark Law

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.

This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the Beneficiary Notices Initiative to alert the Medicare beneficiary prior to rendering the service. The Medicare beneficiary is notified via the Advance Beneficiary Notice (ABN) (see page 235 in Appendix B).

Throughout the past decade restrictions on eligibility for taxpayer-subsidized medical care has risen at both the state and national level. Some of these restrictions are based on laws and reform acts that have been

Any decision naturally means there must be at least two options from which to choose. The decisions made concerning the Affordable Care Act (ACA) are certainly no exception. Certainly politics enters into the mix, as does associated costs, availability of medical care, quality of care and numerous other factors. While the idea medical care for all seems quite simple on the surface, the devil is in the details. My father, Dudley Plaisance, worked in healthcare for many years, even co-founding a company whose role was to find sources of funding for patients without resources to pay medical

The potential opportunity for the state to opt into the Medicaid expansion is the fact that low-income citizens will be insured. The decision of the state to opt into the Medicaid expansion will also impact the state’s budget, and this is the main challenge (Frakt, 2013). The government will cover majority of all the cost even as Medicaid expansion provides coverage for the low-income uninsured citizens. Expansion of the Medicaid is also a broken system that has poor outcomes, not severe federal strings, high inflation and no incentive for the personal responsibility of the citizens who

Throughout the early 1980’s and 1990’s the Federal Medicaid program was challenged by rapidly rising Medicaid program costs and an increasing number of uninsured population. One of the primary reasons for the overall increase in healthcare costs is the

As a health policy analyst for the state of Texas which has not elected to expand Medicaid as part of the Affordable Care Act (ACA) and now has been notified that the state leaders have taking into reconsideration their recent decision during an upcoming session in order that we begin gathering data on the benefits of adapting the Medicaid expansion. As a health policy analyst our goal is to assure data quality, interpret data, and discover new information in the data. Medicaid is a federal and state partnership with shared authority that is a health insurance program for low-income individuals, children, their parents, the people with disabilities and the elderly. Nationally Medicaid covers health care for over 72 million people. Even though participation is optional, all 50 states participate in the Medicaid program. However, Medicaid benefits eligibility varies widely among the states all states must meet federal minimum requirements, but they have options for expanding Medicaid beyond the minimum federal guideline (http://www.ncsl.org/research/health/affordable-care-act-expansion.aspx). In this research we will identify the state of interest which is Texas, compare the state’s decision, determine the alternate approaches to expanding access and provide a recommendation on whether or not the state should opt in to the Medicaid expansion.

Expanding Medicaid under the new Affordable Care Act, or Obama Care as it has been dubbed, is a serious issue affecting not only the 47.5 million citizens on it according the to the U.S. Census Bureau (2012), but also 5.7 million more struggling United States Citizens needing medical care (2014). By expanding Medicaid, it would mean access to affordable health insurance, preventative care and new jobs created. On An 6-3 decision, those incomparable court upheld a discriminating some piece of the moderate mind Act, memorable human services change that the President marked under theory five a considerable length of time agnus dei. Now, a large number about Americans who got secured over wellbeing protection marketplaces could sit tight

The current paper examines the Disproportionate Share Hospital Payment Reduction CMS 2367F rule which was effective on November 18, 2013. The Disproportionate Share Hospital Payment Reduction CMS 2367F is Federal Legislation that was implemented due to the Affordable Care Act. The rule was initially proposed by the Centers for Medicare & Medicaid Services (CMS), HHS on May 13, 2013. The proposed rule was to implement the provision of the Affordable Care Act that reduces Medicaid Disproportionate Share Hospital (DSH) allotments.

Many forms of 1915 and 1115 waivers have been proposed and implemented in Florida and other states in the past. According to Holahan, Coughlin, Lipson, & Rajan (1995), the section 1115 research and demonstration waivers are designed to allow states to develop new solutions to health and welfare problems. The federal government may waive some standard Medicaid rules if the change is deemed to be budgetary, no higher than it would have been expected without the waiver (Holahan et al., 1995). States using these waivers have proposed to save money by using managed care plans for current Medicaid patients, and limiting the cost of new Medicaid enrollees (Holahan et al., 1995).

The Medicaid revisions and expansion under the ACA, exhibited the federal government overstepping their power as they tried to penalize any state governments in opposition of the expansion, consequently, taking away states’ power. The Medicaid Expansion Mandate would’ve compelled states to join due to the loss of federal funding towards Medicaid if they did not adhere to (Phi Le, par.40). The Supreme Court hearing allowed states to have a choice whether or not to participate in the expansion without a total loss of their Medicaid funding. In return, states who didn't participate wouldn’t receive additional funding that coupled with this mandate that required inclusion, extending coverage of those who were at “Income below or ar 133% federal

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).

Pursuant to sections 1128 and 1156 of the Social Security Act, the OIG has the authority to exclude individuals and entities from Federally funded health care programs, like Medicare and Medicaid. The paramount effect of exclusion is that payment is prohibited for items or services that an excluded individual or entity provides. This prohibition extends to anyone who chooses to employ or contract with an excluded individual or entity. Providers who violate this prohibition, are required to pay back any and all Federal funds inappropriately received and may also be subject to civil monetary penalties (“CMP”).

The Medicaid program provide health insurance to low income individuals. Congress passed Medicaid intending to achieve a new benefit package for Medicaid recipients, including "standard pertaining to program eligibility, benefits, and payment to participating healthcare providers." However, there are thousands of administrative regulations and rules pertaining to Medicaid, which have become a controversial topic over the past 40 years. "In the true sense," the passing of the Medicaid regulations has brought "life" and "vitality" to the program. This "operationalizing" function of administrative law is seen a wide range of important health issues, including the "reporting of infectious diseases, the development of sanitation standards, and the

This section outlines the proposed amendments to the Patient Protection and Affordable Care Act, Section 2713-2714. First and foremost, to achieve the goals outlined in by the current policy is difficult, when the vast majority of Americans with chronic illness are unable to afford the health care services needed to manage their conditions. Therefore, this proposal stipulates expanding the bronze package to ensure that low income individuals have access to the services needed to manage their conditions. An alternative to the expansion of the bronze plan is re-evaluating the federally established poverty guideline. The poverty guideline should be re-evaluated to reduce the disparities that exist as a result of the current guideline.