Week 4 Assignment Update.docx - The Stark Law Assignment 2...

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The Stark Law - Assignment 2 Governance and Fraud in Health Care Organizations - Legal and Ethical Responsibilities HMGT 372 Legal and Ethics in Healthcare by Danica Marrett April 9th 2020 Name of the Law and or laws:
Stark Law - Federal Section 1877 of the Social Security Act (the Act) (42 U.S.C 1395nn), also known as the physician self-referral law and commonly referred to as the Stark Law . The Stark Law prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation) unless an exception applies. It also prohibits the entity from presenting or causing to be presented claims to Medicare (or billing another individual, entity, or third-party payer) for those referred services. In addition, the Stark Law, establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse. State Law - Several states have enacted the Stark law including the state of Florida The Patient Self-Referral Act of 1992 (PSRA) 456.053 Financial arrangements between referring health care providers and providers of health care services.— (1) SHORT TITLE. —This section may be cited as the Patient Self-Referral Act of 1992.
(2) LEGISLATIVE INTENT. —It is recognized by the Legislature that the referral of a patient by a health care provider to a provider of health care services in which the referring health care provider has an investment interest represents a potential conflict of interest. The Legislature finds these referral practices may limit or eliminate competitive alternatives in the health care services market, may result in over utilization of health care services, may increase costs to the health care system, and may adversely affect the quality of health care. Management s Financial Responsibilities: The Stark Law is a strict liability statute, meaning that proof of a physician s specific intent to violate the law is not required. Therefore, physicians who make prohibited referrals for designated health services even accidentally or unknowingly will still be subject to civil penalties. 1. The physician may not make a referral to the entity for the furnishing of designated health services for which payment otherwise may be made under this subchapter. 42 U.S. Code § 1395 (a)(1)(A) 2. The entity may not present or cause to be presented a claim under this subchapter or bill to any individual, third party payor, or other entity for

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