Introduction
Given the sharp increase in healthcare prices, healthcare professionals are coming up with innovative cost-containment methods. Every now and then, the healthcare organization may find itself confronted with an ethical choice and find it difficult to make. The case study of Drs. S and V will be examined, and the paper will explore how their actions broke the Stark Law.
Stark Law
Stark Law is a federal law that was created to stop conflicts of interest and Medicaid and Medicare program abuse. Physical therapy, occupational therapy, radiography and imaging services, and radiation therapy are among the approved health services. Every financial arrangement between physicians and organizations offering specified healthcare services must comply with certain exclusions in order to be legal. One exemption is the in-office ancillary services exception, which, if certain requirements are met, permits doctors to offer specific health services in their offices. Another exclusion is the group practice exclusion, which, under certain circumstances, permits doctors in a group practice to refer patients to specific in-group medical services.
Stark Law Violation
The Stark Law was not immediately broken by Drs. V and S when they decided to rent a nuclear camera. Despite the Stark Law’s prohibition on self-referrals for Medicare and Medicaid, there are several exceptions, and doctors may offer DHS services if they approve the service. Doctors are prohibited from engaging in any actions under Medicare and Medicaid that would provide them with a financial gain or an interest under the Stark Law (Tironi, 2009). As the doctors already had a relationship with the hospital and wanted to earn amnesty for admitting patients, they allowed them to utilize the nuclear camera as a compromise. Here was where Dr. S and Dr. V stepped over the boundary between what was legal and illegal. Medicare was invoiced for the services provided while patients were using this nuclear camera.
Legal Parameter for Patient Rights
As healthcare providers, Dr. S and Dr. V have to protect their patients’ rights by complying with all applicable laws and regulations. By leasing a nuclear camera and providing nuclear imaging services to their patients, they acted in their patient’s best interests. However, they also had to ensure they did not violate any laws or regulations. Since the hospital had agreed to the lease of the camera, it suggests that the arrangement was acceptable under the Anti-Kickback and Stark Acts (Collins et al., 2018). Nonetheless, the qui tam action brought against them highlights the importance of healthcare providers being aware of the legal parameters for patient rights and complying with all applicable laws and regulations to protect those rights.
Federal, Statutory, Case Laws
The Anti-Kickback Act forbids healthcare providers from exchanging cash or other benefits with patients they refer or with the purchase or lease of goods or services used in the medical industry. The legislation’s main objective is to stop fraud and abuse in government healthcare programs like Medicare and Medicaid.
Stark Law also forbids healthcare professionals from financially conflicting with the organizations through references they offer to patients. The law’s goal is to stop money from influencing a patient’s choice of treatment.
False claims are not allowed to be submitted to the federal government under the False Claims Act, which is a federal law. The statute permits whistleblowers to bring qui tam actions on the government’s behalf, and they may be entitled to a share of any damages awarded (Bustillos & Vellek, 2019). The defendants in this qui tam action were accused of falsifying certifications of compliance with the Anti-Kickback and Stark Acts in relation to claims made to Medicare.
Conclusion
The Stark Law prevents physicians from referring patients to healthcare that may lead to conflict of interest in order to avoid misuse of government healthcare programs. However, there are some exceptions to this rule, such as the in-office services exception, group practice exception, and fair market value exception. These exceptions allow doctors to receive compensation for healthcare services in certain situations.
References
Bustillos, D., & Vellek, S. A. (2019). Health care ethics and medical law. (2nd ed.). San Diego, CA – Bridgeport Education, Inc.
Collins, A., Clark, K., & George, A. (2018). A Stark Future for the Stark Law? Home Healthcare Now, 36(6), 393.
Tironi, P. (2009). The Stark Reality: Is the Federal Physician Self-Referral Law Bad for the Health Care Industry?Annals Health L., 19, 235.
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