Free Essay About Physician Self-Referral Law
Medicare fraud and abuse results on abusing the system and increases the strain on the Medicare Trust Fund which cost taxpayers billions of dollars while putting beneficiaries’ health and welfare at risk. But there are laws such as Physician Self-Referral Law that will help us avoid such situation. Physician Self-Referral Law, in definition, can be basically characterized as a law for referrals from a doctor. The issue with doctor referral toward oneself is that a doctor alludes a patient to a medicinal office in which he has a money related premium, be it proprietorship, venture, or an organized pay course of action for more picking up toward oneself. Critics of the practice claim an inborn irreconcilable circumstance, given the doctor's position to profit from the referral. They propose that such courses of action may energize over-use of administrations, thus driving up social insurance costs. Likewise, they accept that it would make a hostage referral framework, which constrains rivalry by different suppliers (Stark Law, 2013).
The Stark law prevents fraud and abuse by disallowing certain doctor referrals towards one’s self for designated health services (DHS) that may be paid for via Medicare or Medicaid. In its essential application, the Stark law provides that if (1) a doctor (or a prompt relative of a doctor) has a "money related relationship" with a substance, the doctor may not make a referral to the element for the outfitting of designated health services (DHS) for which installment may be made under Medicare or Medicaid, and (2) the element may not present (or reason to be exhibited) a case to the government medicinal services program or bill to any individual or substance for DHS outfitted as per a denied referral (Lovette, 2014). To expand, it administers the act of alluding a patient to get an administration or visit an office in which that doctor has a money related premium. Case in point, a doctor may be a part holder of a clinic or open attractive reverberation imaging focus. In the event that the doctor alludes patients to that office, he or she may be disregarding the "Physician Self-Referral Act" (Staman, 2014). It additionally restricts the assigned wellbeing administrations element from submitting cases to Medicare for those administrations coming about because of a disallowed referral. Likewise, it creates various particular special cases and gifts the Secretary the power to make administrative exemptions for money related connections that don't represent a danger of system or patient misuse (Medicare Fraud & Abuse, 2014).
As a sample to an infringement, a provider alludes a recipient for a designated health service to a business in which the provider has a money interest. As a clearer life example, a doctor may be a part holder of a healing center or magnetic resonance imaging center and if the doctor refers patients to that office he would be charged by the law.
Many penalties await to the offenders. Those are overpayment/refund obligation, False Claims Act liability, Civil monetary penalties and program exclusion for knowing violations, Potential $15,000 not to exceed $100,000 CMP for each service, Civil assessment of up to three times the amount claimed (Lovette, 2014).
Physician Self-Referral Law truly helps us people to have a right and just medical services by protecting us from some physicians that abuse their advice power for self-greed. It will not just benefit the citizen; thus, it will benefit the future offender for they will think twice and just not do the fraud because the penalties are strong and heavy. And for us simple citizen, our future depends on us so we to be alert and be safe those cheaters out there.
Bennett, M. (n.d.). CRIMINAL PROSECUTIONS FOR MEDICARE AND MEDICAID FRAUD. Retrieved from http://www.aapsonline.org/fraud/fraud.htm
Lovette, M. (2014, April). Medicare Fraud and Abuse 101. Retrieved April 1, 2015, from http://www.aaos.org/news/aaosnow/aug11/advocacy3.asp
Medicare Fraud & Abuse. (2014, August). Retrieved April 1, 2015, from http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Fraud_and_Abuse.pdf
Stark Law. (2013, January 1). Retrieved April 1, 2015, from http://starklaw.org/stark_law.htm
Staman, J. (2014, September). Health Care Fraud and Abuse Laws Affecting Medicare and Medicaid: An Overview. Retrieved April 1, 2015, from http://fas.org/sgp/crs/misc/RS22743.pdf