...IS THERE A STARK LAW VIOLATION IN THIS ARRANGEMENT? Check if applicable A Did a physician or their (Immediate family member)1 make a referral2? B Was the referral to an entity for the furnishing of a Designated Health Service3 (DHS) reimbursable by Medicare/Medicaid? C Is there a Financial Relationship4 between the physician or immediate family member and the DHS Entity5? If a, b and c are checked then there is a prohibition of the Stark Law unless there is an applicable exception to the arrangement. GENERAL EXCEPTIONS6 FOR OWNERSHIP AND COMPENSATION ARRANGEMENTS. 1 Physician Services7 Exception (Group Practice) a Was the DHS furnished personally or supervised by another physician in the same group practice as the...
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...Financial Laws Theodore Gladney Health Services Finance Professor: Alison Williams Financial Laws Five Elements Pertaining To the Establishment of a False Claim under the False Claims Act The five elements necessary to establish a false claim must determine that the claim was in breach of State laws. It must be proved beyond reasonable doubt that the claim was false, fraudulent or fictitious and made for a monetary benefit. The false claim is established when an individual is in possession of a property or money used by the government with the intention to defraud the government (Boese, 2005). It must also be established that the ‘false claim’ was made with actual knowledge. False certification of receipt of property without attempting to confirm the truth of the information provided is also an element that constitutes false claim. Three Broad Objectives of HIPAA Privacy Standards HIPAA privacy standards aims to achieve the following three important objectives: i) Administrative Safeguards HIPAA privacy rules designed procedures and policies regarding the administrative procedures of the act; how will the act be complied with. ii) Physical Safeguards HIPAA privacy rules were designed to control physical access to guard against inappropriate access to personal healthcare information. iii) Technical Safeguards HIPAA privacy rules control access to computer systems and facilitate enclosed entities to protect interactions involving PHI transmitted...
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...Financial Laws & Regulations By Joanna Ramos Professor: Maribel Lebron DeVry University HSM 340 November 3, 2013 1. What are five elements pertaining to the establishment of a false claim under the False Claims Act? * Qui tam – also known as a “whistleblower” and that exposes misconduct, alleged dishonest or illegal activity occurring in an organization. It can be classified in many ways; for example, a violation of a law, rule, regulation and/or a direct threat to public interest , such as fraud health and safety violations, and corruption * Kick Backs - is a form of negotiated bribery in which a commission is paid to the bribe-taker Self * Self-Referrals – This to avoid the abuse of authorities and for misconstruing fraudulent information. * Anti-Kickback State(AKS)- “states that no person may offer or request, give, or receive remuneration in exchange for a referral for a good or service that may be reimbursed under a federal healthcare program (e.g., Medicare)” (Cleverly & Cameron, pg.92). * Stark Law – “The Stark Law prohibits a physician from referring a patient for certain “designated health services” to an entity with which the physician has a “financial relationship”” ( Cleverly & Cameron, Pg.93). 2.HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each. * Health care insurance portability act and accounting act of 1996- This act gives the right to privacy to individuals from age...
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...Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s purpose is to prohibit a physician from referring a patient for designated health services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare Beneficiaries, but Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s...
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...The False claim act is a law that inflicts liability on an individual or company that takes advantage of governmental programs. With the False Claim Act individuals are able to recover money stolen through fraud (False Claims Overview, 2014). According to the Office of Inspector general in order to qualify for financial incentives a state’s false claim act must: • Establish liability to the state for false fraudulent claims • Contain provisions that are at least as effective in rewarding and facilitating qui tam actions for false or fraudulent claims as described in the FCA • You must contain a requirement for filling an action under seal for 60 days • Finally you must contain a civil penalty that is not less than the amount of the civil penalty (State False Claim Act Reviews, 2014). The Health Insurance Portability and Accountability Act (HIPAA) was designed to protect patient privacy. The three objectives that HIPAA was designed to accomplish are: • Determine the circumstances in which protected patient health information is used and disclosed • Establish individual rights in regards to protected information • Ensure that administrative safeguards are adopted to ensure the privacy of patient information Stark law forbids a physician from making certain referrals for certain designated health service (Physician Self Referral, 2014). Ten specific DHS services are as follows: • Clinical laboratory services • Physical Therapy services • Occupational Therapy services ...
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...False Claims Act The False Claims Act was established to prevent intentionally inaccurate claims against or to the government for property or money. This applies to all federal programs, although it is applied to health care most frequently due, in part, to the large dollar amounts involved1, but also to the volume of claims regarding health care made to the federal government each year. There are five elements pertaining to the establishment of a false claim under the False Claims Act; 1) a claim for property or money is made; 2) the claim is against or to a department or agency of the United States; 3) the claim was false, fictitious or fraudulent; 4) the organization, or persons representing the organization, must have known at the time that claim was false, fictitious or fraudulent; and 5) the false, fictitious or fraudulent claim was material.2 Qui Tam. When an individual (relator) brings a lawsuit against an organization claiming violation of the False Claims Act, this is considered a “qui tam” action. A relator’s knowledge, used to bring about a qui tam suit, “must not be public knowledge but information that would not otherwise be available without the qui tam suit.”1 The relator, often referred to as a “whistleblower”, receives a portion of any settlement amount dictated by the results of a qui tam suit. This incentive was established by the False Claims Act and encourages individuals to assist the government in identification of fraud.1 HIPAA Privacy Standards ...
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...Financial Laws and Regulations Tayyaba Baig Devry Fresno HSM 340 July 14, 2013 Ms. Mary Financial Laws and Regulations 1. What are five elements pertaining to the establishment of a false claim under the False Claims Act? According to our text, the five elements pertaining to the establishment of a false claim under the False Claims Act are the government should establish the claim was false and submitted knowingly, government must establish that the person submitted the claim with actual knowledge, in deliberate ignorance, or with reckless disregard for the claim’s truth, or falsity. (Cleverley 90) 2. HIPAA privacy standards were designed to accomplish what three broad objectives? Explain each. The three broad objectives HIPAA privacy standards were designed to accomplish are limit the circumstances in which individuals use and disclose patient health information, establish individual rights regarding patient health information, and require protected individuals to adopt administrative safeguards to protect the confidentiality and privacy of patient healthcare information. According to our text, HIPAA prohibits the disclosure of any individual health information that is transferred or maintained electronically such as emails and faxes. HIPAA privacy standards also ensures that individuals have right of deciding which information should not be disclosed under any circumstances. Finally, HIPAA privacy standards also ensure that all security standards are...
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...Dealing with Fraud By: Kevin McCarthy To: Dr. Michelle Rose HSA 515 Health Care Policy, Law, and Ethics December 13, 2012 Abstract As the Chief Nursing Officer, I am responsible for one of the state’s largest Obstetric Health Care Centers. I have received word of some fraudulent behaviors in the center. I will evaluate how the Healthcare Qui Tam affects health care organizations. I will provide four (4) examples of Qui Tam cases that exist in a variety of health care organizations. I will devise a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals. I will recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. I will devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations Qui tam is shorthand for a Latin phrase that means “he who sues for the king as well as for himself.” In a qui tam case, the whistle – blower (aka relator) files the suit as a kind of “private attorney general” on behalf of the government. The government can choose to take over the prosecution, but if it declines to do so the relator can proceed alone (Showalter). Any person with information about health care fraud can be a qui tam plaintiff. Person is defined as “any natural person, partnership, corporation, association...
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...Dealing with Fraud Liquid Professor Beharry Health Care Policy, Law, and Ethics March 18, 2013 Abstract This paper will evaluate how the Healthcare Qui Tam affects health care organizations while providing (4) examples of Qui Tam cases that exist in a variety of health care organizations. Other responsibilities discussed, are devising a procedure for admission into a health care facility that upholds the law about the required number of Medicare and Medicaid referrals; the ability to recommend a corporate integrity program that will mitigate incidents of fraud and assess how the recommendation will impact issues of reproduction and birth. The know how to devise a plan to protect patient information that complies with all necessary laws. Evaluate how the Healthcare Qui Tam affects health care organizations. The Healthcare Qui Tam affects health care organizations in that well over more than 450 hospitals across the country were the subject of Medicare fraud investigations. Whether or not Medicare violations are found, the costs of responding to an investigation can be significant. Westchester Medical Center of New York, being investigated for possible health care fraud and violations of anti-kickback laws, received a subpoena for extensive records in some thirty-seven categories going back to 1997. Millions of dollars may be spent in legal fees and other costs associated with the investigation (e.g., hiring or reassigning staff to assist with compiling...
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...website. Twin Oaks has a level one trauma center that has 852 beds in all, to accommodate the patients that need our services. Being a level one trauma center we receive all of the most extensive cases and life threatening illnesses that our fellow hospitals can not accommodate. We have six beds set up in the emergency room to be able to perform emergency surgery at the bedside. This helps us give the patient who may not have the time to be prepped for surgery get the care they need immediately. In order to be considered a level one trauma center, we have to have 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care. At the medical center, we have also incorporated a comprehensive quality assessment program in order evaluate and improve patient care and wait times when they arrive at the emergency room. (Trauma Center Levels Explained, n.d.) Twin Oaks offers a full range of diagnostic, medical and surgical specialties in areas such as emergency medicine and trauma, heart and vascular, oncology, orthopedics, neurology, and women’s and children’s services. We are committed to providing the highest overall quality of care and treatment, to have the highest outcomes and performance of our fellow hospitals. We have a committed team of doctors and nurses who are experts...
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...website. Twin Oaks has a level one trauma center that has 852 beds in all, to accommodate the patients that need our services. Being a level one trauma center we receive all of the more extensive cases and life threatening illnesses that our fellow hospitals can not accommodate. We have 6 beds set up in the emergency room to be able to perform emergency surgery at the bedside. This helps us give the patient who may not have the time to be prepped for surgery get the care they need immediately. In order to be considered a level one trauma center, we have to have 24-hour in-house coverage by general surgeons, and prompt availability of care in specialties such as orthopedic surgery, neurosurgery, anesthesiology, emergency medicine, radiology, internal medicine, plastic surgery, oral and maxillofacial, pediatric and critical care. At the medical center, we have also incorporated a comprehensive quality assessment program in order evaluate and improve patient care and wait times when they arrive at the emergency room. (http://www.amtrauma.org/?page=TraumaLevels) Twin oaks offers a full range of diagnostic, medical and surgical specialties in areas such as emergency medicine and trauma, heart and vascular, oncology, orthopedics, neurology, and women’s and children’s services. We are committed to providing the highest overall quality of care and treatment, to have the highest outcomes and performance of our fellow hospitals. We have a committed team of doctors and nurses...
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...Tourism: Questions of International Justice, Economic Redistribution and Health Care Reform Professor Sarah McBride Toro Longe April 18, 2010 M.J. Thesis in Health Law Abstract This is an essay on medical tourism in the United States of America (U.S.). It includes a brief history of the U.S. health care system, examines the social, cultural, ethical, and legal issues that have affected health care changes in America. With the number of Americans going overseas to seek medical care steadily rising, the American insurance industry expanding benefits, and the Joint Commission accrediting facilities for globalization of the health care marketplace, medical tourism should become increasingly important in the health care industry. While there are many reasons for patients seeking health care outside of their own country, one that is particularly easy to overlook is the outsourcing of health care and its effect in U.S. and around the world. The purpose of this paper is to examine the concept of medical tourism, noting the specific medical tourism destinations, presenting reasons for the recent increase in medical tourism, and examining the risks and benefits, as well as wrestling with the challenging ethical and legal issues inherent in medical tourism. The paper will conclude with consideration of the role of the law in medical tourism. Introduction Over the past 100 years, the United States of America (U.S.) has changed greatly in its economic structure, population composition...
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...Fundamentals of Law for Health Informatics and Information Management Second Edition Check Your Understanding Chapter Answers CHAPTER 1 Check Your Understanding 1.1 1. A hybrid record is refers to record that is totally electronic. False 2. An electronic health record can be managed across more than one healthcare organization. True 3. Confidentiality refers to the right to be left alone. False 4. HITECH widens the scope of privacy and security protections under HIPAA. True 5. Privileged communication is a legal concept designed to protect the communication between two parties. True Check Your Understanding 1.2 1. Ownership of a health record generated by a doctor on a patient belongs to the patient. False 2. A custodian of records is responsible for certifying that a record is what it purports to be. True 3. When a patient refuses treatment he or she is exercising the ethical principle of beneficence. False 4. In a malpractice case, a professional code of ethics may be used as a benchmark for what should be acceptable practice by a healthcare professional. True 5. The ethical principle of nonmaleficence refers to making sure rules are fairly and consistently applied to all. False CHAPTER 2 Check Your Understanding 2.1 1. Private law defines rights and duties between individuals and the government. False 2. Statutes are enacted by legislative bodies. True 3. Administrative law is created by court...
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...Health Information Technology (HIT) is becoming increasingly useful and implemented more frequently by health care providers throughout the United States. This technology may include Electronic Health Records (EHR) or Electronic Medical Records (EMR). The shift towards implementing Electronic Health Records has a significant influence on the quality of care provided by health care providers; however, some providers still stick to the basic paper documentation due to skepticism and disregard the benefits to adopting new technologies. Many questions arise when a health care provider is interested in adopting EHR’s, such as why adopt EHR’s? What are the benefits of EHR’s in relation to paper documentation? What steps need to be taken in order to adopt and implement EHR’s? What barriers will be encountered during the decision making process and how will these barriers be addressed? A health practice interested in adopting and implementing an EHR system must establish priorities, identify potential risks and how to avoid or overcome these risks, outweigh the pros and cons, set goals, and adhere to strict guidelines to ensure adopting a successful system. The terms Electronic Health Records (EHR) and Electronic Medical Records (EMR) are often used interchangeably by health care providers when in fact there is a subtle difference between EHRs and EMRs. Electronic Medical Records and Electronic Medical Records are both digital versions of a patient’s medical history and information;...
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...New Medical Devices in the US August 13 2010 Table of Contents 1. Introduction……………………………………………………………………………………………………………………………………2 2. Background and Framework……………………………………………………………………………………………………………4 2.1 Priority Medical Devices for the Netherlands…..……………………………………………………………………4 2.2 The US Vision: From see and treat to predict and prevent……………………………………………………6 2.3 Conclusions…………………………………………………………………………………………………………………………..7 3. Medical device sector in the US………………………………………………………………………………………………………8 3.1 Economic Impact…..………………………………………………………………………………………………………………8 3.2 The Sector by State…..…………………………………………………………………………………………………………10 3.3 Key Institutes: Patent Applications in the Cluster Areas…..………………………………………………….13 3.4 Conclusions…..…………………………………………………………………………………………………………………….20 4. Turning research into novel medical devices………………………………………………………………………………….22 4.1 The Medical Device Development Process…..……………………………………………………………………..22 4.2 CIMIT: A Structure for Medical Device Innovation…..………………………………………………………….23 4.3 Stanford Biodesign: Innovation as a Discipline…..………………………………………………………………..26 4.4 Conclusions and Recommendations…..……………………………………………………………………………….28 5. Summary and Conclusions…………………………………………………………………………………………………………….30 6. Acknowledgements……………………………………………………………………………………………………………………….32 7. References…………………………………………………………………………………………………………………………………….33 Appendices A1 Selection of Key Institutes A2 Results Patent Analysis A3 Research...
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