Stark Law: Consequences for ethical or Legal Breach (Essay Sample)

The Stark Law
Student’s Name
College affiliationThe Stark Law
Stark law, also known as physician referral law (Section 1877, Social Security Act) limits referrals by physicians to establishments that they have vested interest. The Stark Act was an amendment to the Social Security Act and the main objective was to prohibit self referrals. The referrals are in regard to designated health services abbreviated as DHS. The limitations befall people of the family, the doctor, or any person that they could have made a pre-arranged deal on referrals unless they fall within exceptions found in Section 42 CFR Part 411, Subpart J.Claims within the prohibited referrals are also limited and no medicare payment can be paid in case such a case scenario happened.
Management Financial Responsibilities
In order to avoid violations of the Stark law, there is a need to put various measures in place. This way, people within the health services filed who get medicare can avoid making technical errors noted in Stark violations. One of these is the financial relationship sign off. To avoid arrangements with physicians with links to the DHS, and thus, violation of the Stark Law, it is imperative to create specified financial responsibility in which a department reviews indirect and direct financial plans that DHS may keep with referring physicians. Here, the DHS entity may be called to give a conflict/statement of interest yearly on themselves, family members, or direct investments and employment arrangements in order for the entity to identify cases for existence problematic relationships. Another mode of reduction of violations of Stark Law is contract management. In the market, there are already software made to look at contractual management. The software can be used to scan for errors and redundancy in checking the vested interests in the DHS entities by physicians. The software gives the people in-charge the information required when it comes to contract expiry, as well as, creating a searchable repository, and customization of work flows that incorporate checklists and in the process verify the presence of required contractual elements are present as the software alerts whenever there is a violation of the contractual process. Lack of organized databases may be the reason physicians find loop holes to gain in the process. However, the two above methods will ensure that the DHS entity manages the staff making it hard for them to trick the system.
Consequences for ethical or Legal Breach
Over the years, various cases have been forwarded due to violation of the Stark Law. As a result, punishments have been given to the violators, just as in any other crime. In a standard way, and according to the law, people who violate the law get various penalties. These penalties include failure to get the payment for the DHS given, a refund for the monies gotten by physicians, as well as, their facilities for the money collected and a payment of up to fifteen thousand dollars as civil penalties for each service provided in violation, or rather, breach of the Stark Law provided they knew or they should have known. In addition, there is payment of amounts going up to three times the cash rendered in improper payment of the entity from the medicare program and medicaid and other penalties amounting to up to hundred thousand dollars for circumvention of the Stark Law. The cash would be for each of the case of circumvention.
Three case examples involving breaching of the law are as follows:- Tuomey Hospital in Sumter Vs The State (2010). The case had the hospital accused to falsifying claims and violating the Stark Law. They were fined a 45 million dollars for their take in from the years 2004 to 2010. Marion (Ohio) Vs The State (2010). Here, the hospital was penalized and fined an amount of $1.2 million. Halifax Medical Center Vs. The State (2014). Here, the hospital was charged and had o pay $85 Million meant as a fine. Most of the cases of violation of Stark law revolve around fining the person with the mistakes.
Management Remedial steps to Reverse the Non-Compliant Organizations
Some organizations might be clueless regarding how to handle themselves amidst bright physicians who refer patients to their organizations of vested interest just yo reap big. In a hospital, various methods can be used to handle the process such that physicians do not break the Stark law. One method is the checklist method. While this method may sound archaic, it will bring about order in the picture as the checking and counter checking will work towards removing bad seed from amongst the reigns of the physicians in the hospital. Another method is the establishment of a foolproof drafting technique. This method ensures that there is a plan in motion in case of any eventualities. The manner in which the manage handles the techniques and the way these techniques get employed will ensure that there are less cases of violation of the law. The techniques created must be informed through legal decisions made through consultatio...