Stark Law

Only available on StudyMode
  • Download(s): 140
  • Published: March 16, 2013
Read full document
Text Preview
Overview
Overview
Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s purpose is to prohibit a physician from referring a patient for designated health services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare Beneficiaries, but

Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law, or Stark Law, intends to prevent the misappropriation of or over utilization of healthcare that could result from incentivized diagnostic ordering protocols that may be a direct result of financial relationships that could influence healthcare decisions. The law is named for its author, United State Congressman Pete Stark, a Democrat from California, who authored and supported the creation of this piece of legislation. The law’s purpose is to prohibit a physician from referring a patient for designated health services (DHS) to any organization that the physician or a member of his/her immediate family has a financial relationship. Exceptions to the law exist and will be examined in later sections of this reflection. Originally the Stark Law (Stark I) only applied to referrals of Medicare Beneficiaries, but

In the following reflection paper I would like to provide you with a history, definition of terminology, actual case examples and alternative points of perspective from a hospital administrator on how this law has effected the balance of the relationships between hospitals, healthcare providers, and the patients they serve. In the following reflection paper I would like to provide you with a history, definition of terminology, actual case examples and alternative points of perspective from a hospital administrator on how this law has effected the balance of the relationships between hospitals, healthcare providers, and the patients they serve. Stark Law: Protection or Regression?

Stark Law: Protection or Regression?
Stark Law
Stark Law

ever-increasing state budget pressures have increased with the poor performing economy, State funded programs like Medicaid have been included in the scope of the law indirectly (Stark II). Although the Stark I does not specifically restrict a physician or immediate family member from such referral patterns, Stark II contains a provision that does not allow states to receive Medicaid payment for designated health services that would violate Stark I criteria if furnished to a Medicare patient. This creates a dilemma for the state as it could risk loosing the matching federal Medicaid funds for such services if a violation occurs. For the purposes of this review, I will focus on Stark II Phase III of the final rule. ever-increasing state budget pressures have increased with the poor performing economy, State funded programs like Medicaid have been included in the scope of the law indirectly (Stark II). Although the Stark I does not specifically restrict a physician or immediate family member from such referral patterns, Stark II contains a provision that does not allow states to receive Medicaid payment for designated health services that would violate Stark I criteria if furnished to a Medicare patient. This creates a dilemma for the state as it could risk loosing the matching federal Medicaid funds for...
tracking img