DDHA 8600 Diss 2 Week 11
By Day 4 Post a description of Stark and anti-kickback statutes for compliance within your health services organization. Then, describe what statutes you might address from compliance perspective as a current or future healthcare administration leader. Be specific and provide examples. Explain how your efforts to comply with these statutes address safe harbors and be specific about their relevance for your health services organization.
Medicare, Medicaid and Stark Law
It is illegal under both the Medicare and Medicaid statute for physicians to lobby or receive
anything of value, to bribe or provide a reward for referrals, or practices that would generate
business from any federal healthcare programs. Moreover, under Stark Law, no intent standard is
required for a violation of overpayment, however, proof of intent is required for a civil monetary
penalty of knowing illegal acts (Stevenson, Spittal, & Studdert, 2013). The Medicare program
will not pay for services received that are a violation of the statute and need a refund if payment
was received.
Additionally, penalties under Stark Law are indictable by fines up to $15,000 for each
service with civil assessment up to three times the amount claimed and exclusion from
participation in Medicare and Medicaid programs (Kropf, 2017). Currently, the Stark Law
prohibits a physician from referring Medicare patients to entities for the provision of designated
health services (DHS) if the physician or an immediate family member has a direct or indirect
financial relationship with that entity; an entity that furnishes DHS pursuant to a prohibited
referral from billing the Medicare program or any individual, third-party payer, or other entity
for the DHS. Finally, any physician or other entity that enters into an arrangement or scheme
such as a cross-referral arrangement that the physician or entity knows or should know has a
principal purpose of assuring referrals by the physician to a entity which, if the physician directly
made referrals to such entity, would violate the Stark Law, is subject to a civil money penalty of
not more than $100,000 for each such arrangement or scheme (Sandrick, 2008).
Anti-kickback Statute
Anti-Kickback Statute and Stark Law both support elimination of fraud and abuse,
however, the penalties and intent vary. For instance, Stark Law applies specifically to Medicare
and Medicaid programs while the Anti-Kickback Statute applies to all federal health care
program. Therefore, violation of the Anti-Kickback Statute requires unlawful intent and is
punishable by civil, administrative, and criminal penalties; violation of Stark Law has no intent
standard for overpayment. However, civil penalties require a knowing intent for liability
(Goldberg, 2002).
In addition, some potential; ethical concerns in situations protected by safe harbors may
be people taking advantage of abusing the system as under the safe harbor, physicians can
engage in the very conduct that would ordinarily be considered a violation. For instance, when a
provider has an investment interest in small healthcare companies, such as an ambulatory surgery
center, the physician must make an ethical decision that the referral is really in