Assignment 2.odt - The Anti-Kickback Statute The Stark Law...

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The Anti-Kickback Statute & The Stark Law By Jelena Cress HMGT 372 7982 Due date: November 16 th , 2015 Professor Joseph Wade
Governance and Fraud in Health Care Organizations - Legal and Ethical Responsibilities 1. Name of the Laws : The Anti-Kickback Statute (42 USC § 1320a-7b(b)) prohibits offering, paying, soliciting and receiving anything of value to induce, reward referrals, or generate Federal health care program business. 1 The intent to violate this statute has to be proven and all referrals are included. Penalties for violating this statute include criminal and civil punishment. Criminal punishment under sections 1128B(b) and 1128B(f) of the Act (42 U.S.C. 1320a–7b(b) involves fines up to $25,000 per violation, up to a 5 year prison term per violation. Civil punishment includes: False Claims Act liability, civil monetary penalties and program exclusion, potential $50,000 CMP 2 per violation, civil assessment of up to three times amount of kickback. Exceptions include voluntary safe harbors. This Statute applied to all Federal Health Care Programs (Department of Health and Human Services, 2013). The Stark Law (42 USC § 1395nn) prohibits a physician from referring Medicare patients for designated health services to an entity with which the physician (or immediate family member) has a financial relationship, unless an exception applies. This law prohibits the designated health services entity from submitting claims to Medicare for those services resulting from a prohibited referral. This law involves only a physician’s referrals violation. The intent of violating this statute does not have to be proven, it is a strict liability. Intent is required for civil monetary penalties for knowing violations. Only civil penalties are imposed for violating this law. Penalties for violations include: overpayment or refund obligation, False Claims Act 1 Remuneration includes kickbacks, bribes, rebates made in cash or in kind. The payment of remuneration intended to induce or reward the purchasing, leasing, or ordering of, any god, facility, service, or item reimbursable by any Federal health care program (Department of Health and Human Services, 2013). 2CMP - the civil monetary penalty
liability, civil monetary penalties and program exclusion. For known violations, potential $15,000 CMP for each service, and civil assessment of up to three times the amount claimed can be assessed. The Stark Law includes mandatory exceptions and is enforced only when physicians work with Medicare and Medicaid Federal Health Care programs (HEAT, n.d.). The Stark Law’s personal service arrangement exception contains a “set in advance” compensation requirement. 3 This exception has to be time-based, per unit of service based amount, or a specific formula for calculating the compensation which is set in an agreement between the parties before the furnishing of services and the compensation that is to be paid. The formula must be set forth in sufficient detail so that it can be objectively verified. The formula

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