Why The Physician Self Referral Law Or Stark Law

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.

for Medicare? Indeed, the provider status that we fight for is only for Medicare reimbursement and recognition. Why does this

H.R. 6261promotes the utilization of not only primary care services provided by Accountable Care Organizations (ACO’s) physicians, but also those provided by other ACO such as nurse practitioners, to increase patient access to quality care while reducing costs in underserved areas.

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

Contrasting it to today's laws, instead of cutting failed surgeon's hands-off, doctors not able to save people are a given and it happens every day with no actual

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.

This newer reimbursement system has been a topic of contention amongst a large portion of the professional medical community due to the perceived unfairness that it brings in certain situations where a patient must be readmitted and, as a consequence, the primary care providers may not be reimbursed for the readmission regardless if they were responsible. With the introduction of the Affordable Care Act in 2010, further criteria such as the Readmissions Reduction Program have been added that determines the eligibility of a primary care provider being reimbursed through the Medicare/Medicaid program. These new requirements have led to new avenues of contention amongst healthcare professionals and, in some cases, new avenues for fraud and patient discrimination.

Therefore, reimbursement to APRNs is limited for the many services that are provided to patients (Yee, Boukus, Cross & Samuel, 2013). In Florida, legislative sessions are held at specific dates throughout the year. According to the Florida Association of Nurse Practitioners (FLANP), three specific bills of interest that affect ARNP scope of practice: “SB 96 is proposed in to allow ARNPs to be medical directors; S634/HB 645 will enable ARNPs to sign Certificates of Involuntary Commitment (Baker Act) and CS HB129 will declare all Floridian ARNPs to be medical directors and gain signature ability and HB 7011 which initiates independent full practice for NPs” (Florida Association of Nurse Practitioners (FLANP), 2017).

Healthcare reform continues in a time where a new president has taken office and is attempting to change or “bridge gaps” in health care policy. Currently, NPs are focused on a new shift to prevent disease rather than to solely cure or treat it which is the major difference between physician practice and the nursing profession. NPs receive extensive schooling and clinical practice to achieve full practice rights, however, the restrictions continue. The Florida Association of Nurse Practitioners (FLANP) monitors Florida legislative sessions on regards to the scope of NPs. As of March 7th, 2017, Bills of interest that affect full practice authority in the state of Florida are: “HB 7011 which introduces independent practice for NPs; CS HB129: which allows NPs to be medical directors and gain signature authority; SB 96 which allows NPs to be medical directors and S634/HB 645 which allows NPs to sign Certificates of Involuntary Commitment (Baker Act)” (Florida Association of Nurse Practitioners (FLANP), 2017). If these bills are finally approved all bilingual NPs can address many patients in need of healthcare without any barriers as to which provider they can see.

These plaintiffs (patients) desire admission to the defendant hospitals for the treatment of their illness, and to be treated by their present physician or dentist, without discrimination on the basis of race.

Contrary to this, anecdotal reports stated that other clinicians sometimes spend more times in checking and treating patients with severe illnesses or who are in critical conditions, which made the physicians care for a greater number of patients with lower acuity. Whenever a physician and clinician bill for the same service, it is very difficult to tell if the physician saw a more complex patient. Due to these uncertainties in comparing their services, the Commission is reluctant in altering the payment differential. From that discussion, every provider must be familiar with some fundamentals about Medicare. First and foremost, there is Medicare Part A, which actually covers skilled nursing home, hospital, and home health charges; and then there is Medicare Part B, which then envelops most outpatient services, the care that patients in particular obtain from a doctor’s office (Fishman, 2002).

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

Failure to adhere to regulatory compliance can impact a litigation process, which in the case of Stevens vs, Hickman Community Hospital was prominent when the Tennessee Court of Appeals dismissed the case based on failure to comply with Tennessee’s Medical Malpractice Act and the Health Insurance Portability and Accountability Act of 1996. This paper will include an IRAC Brief that will explain the case in detail followed by a brief explanation of governmental principles of regulatory compliance requirements, a brief explanation of methods for managing the legal risks that arise from regulatory compliance issues, and how this

Professor George Annas, a leading authority on medical law and ethics and the legal editor of the New England Journal of Medicine, wrote this about the MSEHPA:

It is this author’s belief that no entities should stand in the way of an individual’s right to seek counsel, regardless of outcome. The ramifications of not suing a HMO could demonstrate no evidence to support efforts to amend the current law, and without legal documents demonstrating the consequences related to denial of care, the rights of patients, to ensure a safe and effective health care, according to standards of practice, may be compromised.