DQ 4-1

Re: Topic 4 DQ 1

1.

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 $10,781 to $21,563 per claim” (Ellison, 2017).

References: Ellison, A. (2017). 15 things to know about Stark Law. Retrieved from: https://www.beckershospitalreview.com/legal-regulatory-issues/15-things-to-know-about-stark-law-021717.html

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 https://www.physicianspractice.com/blog/stark-law-understanding-rule

Tharp, J. (2014). Stark Law and the Affordable Care Act: Bridging the Disconnect. Journal of Legal Medicine, 35(3), 433–444. https://doi-org.lopes.idm.oclc.org/10.1080/01947648.2014.936226

3.