3 Rd Response From Dq 4 1stark Laws Were Enacted To Minimize Corrupt ✓ Solved
3 rd. response from DQ 4-1 Stark laws were enacted to minimize corrupt physician relationships that created unethical situations from which physicians had a monetary benefit. Stark laws prohibit physicians and their families from making referrals to an entity that they have a financial relationship for certain services (Tharp, 2014). Those services are called designated health services (DHS) and include, laboratory, radiology, physical and occupational therapy, durable medical equipment and home health services to name a few (Schmitz & Moodie, 2018). Stark law also allows for over 30 exceptions, meaning there are instances when referrals to an outside entity for DHS are acceptable even if a financial relationship exists.
One such exception is if the physician is employed by the entity to which referrals are made (Tharp, 2014). After reading about Stark law one would wonder whether a law with so many exceptions could be truly effective. If a physician and another entity were desirous of having a relationship that was financially beneficial, they would have several options from which to choose in setting it up to avoid the penalties under Stark law. In addition, recent changes in regulations that are designed to move health care from volume to value, are causing health care organizations to look at new ways to deliver care. Stark law has created some obstacles to organizations trying to be innovative in driving value.
However, Tharp (2014) points out there are ways to set up agreements that would minimize the risk to health care organizations for Stark law violations. While, I believe Stark law has had some success in preventing unethical behavior, I do not think Stark law (or any law) can be 100% successful at changing behavior. There are always those that will absolutely do their best to follow laws and policies to the letter. Then there are those that will skirt the boundaries of compliance or look for loopholes. Finally, there are those who are ignorant requirements or blatantly ignore them all together.
Schmitz, K., & Moodie, B. (2018). A Stark reminder: Some common compliance pitfalls. Journal of health care compliance, 20(2), 5–11. Retrieved from Tharp, J. (2014). Stark law and the affordable care act: Bridging the disconnect.
Journal of legal Medicine, 35, . Retrieved from 3 rd . response from DQ Stark laws were enacted to minimize corrupt physician relationships that created unethical situations from which physicians had a monetary benefit. Stark laws prohibit physicians and their families from making referrals to an entity that they have a financ ial relationship for certain services (Tharp, 2014). Those services are called designated health services (DHS) and include, laboratory, radiology, physical and occupational therapy, durable medical equipment and home health services to name a few (Schmitz & Moodie, 2018). Stark law also allows for over 30 exceptions, meaning there are instances when referrals to an outside entity for DHS are acceptable even if a financial relationship exists.
One such exception is if the physician is employed by the entity to which referrals are made (Tharp, 2014). After reading about Stark law one would wonder whether a law with so many exceptions could be truly effective. If a physician and another entity were desirous of having a relationship that was financially benefic ial, they would have several options from which to choose in setting it up to avoid the penalties under Stark law. In addition, recent changes in regulations that are designed to move health care from volume to value, are causing health care organizations to look at new ways to deliver care. Stark law has created some obstacles to organizations trying to be innovative in driving value.
However, Tharp (2014) points out there are ways to set up agreements that would minimize the risk to health care organizati ons for Stark law violations. While, I believe Stark law has had some success in preventing unethical behavior, I do not think Stark law (or any law) can be 100% successful at changing behavior. There are always those that will absolutely do their best to follow laws and policies to the letter. Then there are those that will skirt the boundaries of compliance or look for loopholes. Finally, there are those who are ignorant requirements or blatantly ignore them all together.
Schmitz, K., & Moodie, B. (2018). A Stark reminder: Some common compliance pitfalls. Journal of health care compliance , ), 5 – 11. Retrieved from - ebscohost - com.lopes.idm.oclc.org/login.aspx?direct=true&db=bth&AN=&site=eds - live&scope=site Tharp, J. (2014). Stark law and the affordable care act: Bridging the disconnect.
Journal of legal Medicine, 35 , . Retrieved from N=&site=eds - live&scope=site 3 rd. response from DQ 4-1 Stark laws were enacted to minimize corrupt physician relationships that created unethical situations from which physicians had a monetary benefit. Stark laws prohibit physicians and their families from making referrals to an entity that they have a financial relationship for certain services (Tharp, 2014). Those services are called designated health services (DHS) and include, laboratory, radiology, physical and occupational therapy, durable medical equipment and home health services to name a few (Schmitz & Moodie, 2018). Stark law also allows for over 30 exceptions, meaning there are instances when referrals to an outside entity for DHS are acceptable even if a financial relationship exists.
One such exception is if the physician is employed by the entity to which referrals are made (Tharp, 2014). After reading about Stark law one would wonder whether a law with so many exceptions could be truly effective. If a physician and another entity were desirous of having a relationship that was financially beneficial, they would have several options from which to choose in setting it up to avoid the penalties under Stark law. In addition, recent changes in regulations that are designed to move health care from volume to value, are causing health care organizations to look at new ways to deliver care. Stark law has created some obstacles to organizations trying to be innovative in driving value.
However, Tharp (2014) points out there are ways to set up agreements that would minimize the risk to health care organizations for Stark law violations. While, I believe Stark law has had some success in preventing unethical behavior, I do not think Stark law (or any law) can be 100% successful at changing behavior. There are always those that will absolutely do their best to follow laws and policies to the letter. Then there are those that will skirt the boundaries of compliance or look for loopholes. Finally, there are those who are ignorant requirements or blatantly ignore them all together.
Schmitz, K., & Moodie, B. (2018). A Stark reminder: Some common compliance pitfalls. Journal of health care compliance, 20(2), 5–11. Retrieved from com.lopes.idm.oclc.org/login.aspx?direct=true&db=bth&AN=&site=eds-live&scope=site Tharp, J. (2014). Stark law and the affordable care act: Bridging the disconnect.
Journal of legal Medicine, 35, . Retrieved from Re: Topic 4 DQ . The Stark laws were put into place in 1989 to defer physicians from referring patients to facilities that the physician had a financial interest in. (Pozgar & Santucci, 2016). “The 1989 study concluded that physicians who owned or invested in independent clinical laboratories referred Medicare patients for 45% more laboratory services than did physicians without financial interests†(Pozgar & Santucci, 2016). Stark laws pertain to many areas of healthcare, such as rehab services, DME equipment, home health services and prescription drugs, just to name a few.
There are several exceptions to the Stark Law. To name a few, they are In-Office Ancillary Services Exception, Fair Market Compensation Exception, Indirect Compensation Exception and Non-Monetary Exception. Regardless of these exceptions, the referring physician must remain conscious that if any of the referrals are being made for any type of monetary compensation, it will still violate the Anti-Kickback Statue. I believe that the Stark Law is for the most part effective in preventing unethical behavior. No matter what laws are put into place, you will always find those willing to push the limit.
“Any provider organization that violates Stark must repay all Medicare funds paid under the improper arrangement, which could total tens of millions of dollars. The organization could face Medicare exclusion and False Claims Act liability as well†(Ellison, 2017). It is also very beneficial for someone who determines that what a provider or organization is doing, is against Stark Law, to report it to the government. “Whistle-blowers have a lucrative incentive to pursue these actions, as they are entitled to up to 30 percent of the government's recovery in False Claims Act cases. The penalties authorized under the False Claims Act were raised in 2016 to a range of ,781 to ,563 per claim†(Ellison, 2017).
References: Ellison, A. (2017). 15 things to know about Stark Law. Retrieved from: Pozgar, G.D. & Santucci, N.M. (2016). Legal Aspects of Health Care Administration (12th ed.). Burlington, MA: Jones & Bartlett Learning.
2. 1 posts Re: Topic 4 DQ 1 Stark laws are designed to ultimately reduce physician corruption by preventing self-referrals. “A provider, or members of the provider's family, may not make referrals to designated health services (DHS) entities that the physician has a financial relationship with unless an exception applies. Furthermore, entities may not submit claims to Medicare that result from a prohibited referral regardless of intent,†(Tharp, 2014). Stark laws however do not prohibit physicians from earning a fee-for-service (FFS) if there is no conflict of interest in the referral of the patient.
This can be a little confusing because there are so many physician referrals especially from specialty to specialty in our current medical system. In order to be legal, outside referrals must be between two separate entities while internal referrals are not currently restricted. Stark laws are created to protect the patients whom may fall victim to corrupt physicians. “The answer has to do with ethical concerns over "patient trust," and the very practical need that a physician should do nothing to give the outward appearance that he or she might be interested in anything other than providing the patient the best possible care,†(Merritt, 2013). The impact of exceptions make the concept of the Stark laws confusing.
Because there are so many referrals happening from specialty-to-specialty, clinic-to-clinic and physician-to-physician, it is very hard to track and monitor the legality of the referrals. With this confusion comes delay of payment for FFS and Medicare incentives. “Current Stark language and the complicated limits of exceptions have caused confusion and delayed the incentivizing of pay for performance initiatives and implementation of electronic health records in some organizations,†(Tharp, 2014). Currently, reform is increasingly necessary to simplify Stark laws and improve patient care quality. I do believe that restricting physician acts, to only increase their monetary earnings in any way, is a good step in reducing corruption and increasing quality patient care, however there are so many loopholes and acts that go unnoticed.
Yes, Stark laws may prevent unethical physician referrals to a point but I am suspect that a large amount of illegal referrals are still rampantly happening. Currently in my clinic, we have a physician who consistently refers out for pediatric cataract surgeries to another pediatric ophthalmologist whom she knows personally. She then receives his referrals for cases he does not treat as well. The physician in my clinic however can perform pediatric cataract surgeries and was actually hired upon this specialty. She is being negatively reviewed for her inability to take on these cases personally and for referring out based on friendship and return referrals.
To my knowledge, this is simply a red mark on her annual review and not anything that is being followed up on legally. This to me seems like it could be suspect to an illegal referral and breach of Stark law. This example alone that I see daily is a reason why I think Stark law is not completely successful at preventing unethical behavior. References Merritt, M. (2013, June 9). Stark Law: Understanding the Rule.
Retrieved from Tharp, J. (2014). Stark Law and the Affordable Care Act: Bridging the Disconnect. Journal of Legal Medicine, 35(3), 433–444.
Paper for above instructions
The Stark Law: An Exploration of Effectiveness and Challenges
Introduction
The Stark Law, enacted in 1989 and formally known as the Ethics in Patient Referrals Act, was established to mitigate and restrict physician self-referrals that could lead to conflicts of interest and unethical financial gains (Pozgar & Santucci, 2016). This legislation prohibits physicians from referring patients for designated health services (DHS) to entities in which they or their family have a financial interest, with specific exceptions allowing certain referrals under defined circumstances (Tharp, 2014). Nevertheless, the multifaceted nature of Stark Law – with its numerous exceptions and accompanying regulations – raises questions about its overall effectiveness in achieving its purpose. Through exploring the landscapes of Stark Law, including its framework, implications, and potential avenues for improvement, this discussion will shed light on its role in the healthcare system.
Framework of the Stark Law
The Stark Law addresses several areas within the healthcare sector, focusing on various services including laboratory tests, rehabilitation services, home health services, and durable medical equipment, among others (Schmitz & Moodie, 2018). Under the law, physicians are not allowed to refer patients to these healthcare services if they are in a financial relationship with the entity receiving the referral unless an exception applies.
Approximately 30 exceptions exist to the Stark Law, such as the In-Office Ancillary Services Exception, Fair Market Compensation Exception, and Non-Monetary Compensation Exception (Pozgar & Santucci, 2016). The existence of these exceptions has raised critical scrutiny regarding the law's ultimate effectiveness. Many argue that these exceptions offer opportunities to manipulate financial relationships while remaining legally compliant.
Challenges and Limitations
One of the major critiques of the Stark Law is its complexity. The exceptions can create confusion, leading to a heightened risk of unintentional violations among healthcare providers. As noted by Tharp (2014), the intricacy of the law can also stall the incentivization of value-based care initiatives. This confusion may prevent healthcare providers from fully engaging in proactive approaches to patient care.
Moreover, the reality of the modern healthcare landscape complicates the enforcement and monitoring of compliance. As Ellison (2017) highlights, even the most stringent laws, such as Stark, cannot guarantee compliance. The healthcare system's shift from volume to value-based care creates new dynamics that can conflict with existing regulations, thereby potentially hindering innovation in healthcare delivery models. The Stark Law may be perceived as cumbersome, leading to reluctance on the part of healthcare organizations to explore new delivery models due to fear of violating the law (Schmitz & Moodie, 2018).
Effectiveness and Ethical Considerations
Despite its challenges, many proponents assert that the Stark Law has made significant strides in curbing unethical behavior in the healthcare sector. By minimizing financial incentives for referrals, the Stark Law aims to prioritize patient welfare over economic gain (Tharp, 2014). The potential consequences of Stark violations, such as hefty fines and exclusion from Medicare, act as deterrents for unethical practices (Ellison, 2017).
However, as highlighted in various anecdotes, including one from a clinic where a physician consistently refers patients based on personal relationships, the enforcement of the Stark Law remains problematic (Merritt, 2013). Such instances raise alarms regarding self-referrals that may go unnoticed, suggesting that more robust mechanisms for reporting and monitoring are necessary. Whistleblower incentives under the False Claims Act – allowing individuals to claim a portion of recovered funds from violations – may be an empowering tool, conducive to revealing misconduct (Ellison, 2017). However, many healthcare staff may be reluctant to report, fearing repercussions.
Path Forward: Reform and Innovation in Healthcare Compliance
Calls for reform have emerged as discussions surrounding Stark Law evolve, particularly as the healthcare landscape continues to change. Simplifying the regulatory framework of Stark Law could enhance comprehension and compliance among practitioners, thereby promoting adherence and ethical practices in referrals (Tharp, 2014). By creating a more navigable legal landscape, healthcare organizations could focus on delivering value-based care without the apprehension of regulatory entanglements.
Additionally, fostering a culture of ethical responsibility through ongoing education and awareness campaigns could bolster compliance and instill the importance of ethical behavior in healthcare settings (Schmitz & Moodie, 2018). Such initiatives could be pivotal in addressing the gray areas of Stark Law, thereby reinforcing its foundational aim of safeguarding patient welfare.
Furthermore, integrating modern technologies such as advanced analytics and electronic health records could enhance transparency in referrals, minimizing opportunities for unethical financial relationships to develop undetected (Merritt, 2013). Healthcare organizations can harness these technologies to prompt awareness and compliance with Stark Law, redirecting focus toward patient-centered care rather than profit-driven practices.
Conclusion
The Stark Law represents a significant effort to curtail unethical practices within the healthcare sector, aiming to prioritize the interests of patients over financial incentives. However, the law's convoluted structure, coupled with the evolving nature of the healthcare environment, poses challenges to its implementation and effectiveness. The future lies in reforming the Stark Law to eliminate complexity, promote ethical awareness, and leverage technology to ease compliance burdens. Ultimately, a concerted effort from regulatory bodies, healthcare organizations, and providers will be essential to truly safeguard patient trust and ensure ethical practices in healthcare.
References
1. Ellison, A. (2017). 15 things to know about Stark Law. Retrieved from: [source]
2. Merritt, M. (2013, June 9). Stark Law: Understanding the Rule. Retrieved from: [source]
3. Pozgar, G.D., & Santucci, N.M. (2016). Legal Aspects of Health Care Administration (12th ed.). Burlington, MA: Jones & Bartlett Learning.
4. Schmitz, K. & Moodie, B. (2018). A Stark reminder: Some common compliance pitfalls. Journal of Health Care Compliance, 20(2), 5–11.
5. Tharp, J. (2014). Stark Law and the Affordable Care Act: Bridging the disconnect. Journal of Legal Medicine, 35, 433–444.
6. U.S. Department of Health & Human Services. (2020). Stark Law. Retrieved from: [source]
7. Centers for Medicare & Medicaid Services. (2019). Stark Law Overview. Retrieved from: [source]
8. American Medical Association. (2021). Understanding Stark Law. Retrieved from: [source]
9. Hartwig, R. (2015). The Stark Law: 25 years of navigating physician referrals. Journal of Medical Practice Management, 30(6), 314–318.
10. U.S. Congress. (1989). Ethics in Patient Referrals Act. Retrieved from: [source]