Assignment: The Stark Law intends to prevent and detect kickbacks in the delivery of health care Assignment: The Stark Law intends to prevent and detect kickbacks in the delivery of health care Question 1. The Stark Law intends to prevent and detect kickbacks in the delivery of health care. From the readings and independent research, find two specific real life examples of how kickback arrangements would violate the Stark Law and discuss with your colleagues how the kickback arrangements could violate trust between provider organizations and patients. Consider using the terms transparency, patient choice, and informed consent. Read the background articles but this discussion will take research beyond the above articles. Provide citation of authority to support your initial response to conference questions. Peers are expected to demonstrate critical thinking in their questions related to the classmates descriptions. Initial response to discussion topic must be no later than midnight Thursday and then you must substantively respond to at least 2 classmate submissions no later than 6pm Sunday. See Discussion Requirements in Discussion topic entitled ?Discussion Expectations and Grading? No duplication. Redundant primary posts will not be graded. Must adhere to grading rubric for discussions. Background sites to read http://www.cms.gov/ [CMS] http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf http://www.justice.gov/civil/docs_forms/C-FRAUDS_FCA_Primer.pdf[breakdown of The False Claims Act] The Stark Truth about the Stark law Part I, http://www.aafp.org/fpm/2003/1100/p27.html http://www.policyarchive.org/handle/10207/6087[SCHIP] http://www.cms.gov/ [CMS] http://www.justice.gov/civil/docs_forms/C-FRAUDS_FCA_Primer.pdf [breakdown of The False Claims Act] The Stark Truth about the Stark law Part I http://www.aafp.org/fpm/2003/1100/p27.html http://www.csrees.usda.gov/business/awards/ombcirculars.html [OMB circulars are an essential reference or ?how to? legal guide for any organization receiving federal grant dollars or state flow through dollars.] http://www.familiesusa.org/assets/pdfs/SCHIP-101.pdf [SCHIP] http://www.crowell.com/documents/docassocfktype_articles_919.pdf [Deficit Reduction Act] ORDER INSTRUCTIONS-COMPLIANT NURSING PAPERS Question 2. The False Claims Act is a federal law that addresses fraud. Defrauding the U.S. Government, specifically Centers for Medicare and Medicaid Services has consequences. From the readings and from the CMS website, discuss with your colleagues 1. two specific real life examples of a breach of the False Claims Act by a health-related organization, found on the internet or in the print media. Remember, organizations are made up of individuals. 2. In addition discuss whether health care organizations are properly equipped to ensure compliance and minimize exposure risks. If not why not? Background sites to read ? http://www.cms.gov/ [CMS] http://oig.hhs.gov/compliance/provider-compliance-training/files/StarkandAKSChartHandout508.pdf http://www.justice.gov/civil/docs_forms/C-FRAUDS_FCA_Primer.pdf [breakdown of The False Claims Act] Brown, J. (2008). Develop a policy for amended records. Journal of Health Care compliance, January-February, 37- 38. [must use UMUC library] Mekel, M. (2012). The Health Care Quality Improvement Act of 1986 Meets the Era of Health Care Reform: Continuing Themes and Common Threads. Journal of Legal Medicine, (33), 106. [must use UMUC library] http://www.policyarchive.org/handle/10207/6087[SCHIP] http://www.crowell.com/documents/docassocfktype_articles_919.pdf [Deficit Reduction Act] Assignment: The Stark Law intends to prevent and detect kickbacks in the delivery of health care Order Now

ADDITIONAL DETAILS 

The Stark Law

Introduction

The Stark Law has been around for about 25 years. It governs some forms of Medicare payments, such as those related to referrals. The law says that if an organization is providing services on behalf of another organization and that second organization does not have its own money to pay for these services, then the first-mentioned organization must pay all or part of the cost incurred by the second organization.

The Stark Law has been around for about 25 years.

The Stark Law has been around for about 25 years. It was enacted in 1989, named after Congressman Pete Stark and its purpose is to prevent healthcare providers from making referrals for Medicare-covered services in exchange for a kickback or other compensation.

The law is aimed at stopping fraud and abuse from providers who receive kickbacks or other forms of compensation for referring patients to their own facilities or those owned by others. As a result, Stark Law has become one of the most important regulations in healthcare today.

What does the Stark Law say?

The Stark Law is a federal statute that prohibits certain referrals by healthcare providers and prevents the receipt of compensation for such referrals.

The law applies to:

• HMOs (health maintenance organizations) as well as other types of insurers;

• Hospitals that are licensed by states or territories; and

• Certain medical facilities owned by nonprofit corporations.

In other words, Stark Law prohibits any physician from referring a patient for healthcare services that are paid for by Medicare if the physician or a member of his/her immediate family has a financial relationship with the providerThe law does not apply to: Physicians who are employed by health plans or hospitals; Nonprofit facilities that provide medical services; and Physician assistants, nurse practitioners, clinical psychologists and other non-physician providers of health care..

Violations of the Stark Law can be expensive.

The Stark Law can be expensive. If a company or organization violates the law, it is required to pay a fine of up to $250,000 per violation. This amount is not fixed and can increase depending on the severity of your actions. In addition, there may be other penalties such as suspension or revocation of business licenses that arise from violations under this law.

Stark Law fines and penalties are determined by an administrative hearing board at DHFS which hears cases that were filed before June 1st 2014 (the date when Medicaid began covering dental services). Since this was an amendment to our state constitution, only those who were found guilty would have their cases heard before this board; however since these decisions are subject to appeal within 90 days after being issued by DHFS’ administrative hearings division staff members may request reconsideration within 30 days after receiving notice from them about their decision (see below).

The Stark Law governs some forms of Medicare payments, such as those related to referrals.

The Stark Law governs some forms of Medicare payments, such as those related to referrals. It also applies to some Medicaid payments and other health care programs.

The law states that no person or entity may pay any amount of compensation for the provision of items and services listed in the federal Fair Labor Standards Act (FLSA). These items include:

• Ambulance services

• Emergency medical response services (EMS) by air ambulance vehicles, ground ambulances, or motor vehicles equipped with emergency medical equipment including ECG monitors and defibrillators made available by public agencies;

• Hospital facilities maintained by state governments or local governments, including hospitals licensed by the U.S. Public Health Service Act; and others not listed above which provide similar health care services as determined by HHS through rulemaking authority under section 1877(b)(2)(B) of Title 42 U S Code Section 1395x part C subsection E1#10

Conclusion

The Stark Law has been around for about 25 years. It is a complex statute that governs some forms of Medicare payments, such as those related to referrals. The law was enacted in an attempt to make sure that healthcare providers were not paid by the federal government based on inflated patient claims or other abuses. This can be done through a process called “overbilling” or “upcoding” where doctors and nurses submit false information on their Medicare billing practices in order get more money from Medicare than they deserve for services rendered – which would mean they are overcharging taxpayers on their patients’ behalf!

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