Question

Provide an example of a recent Stark Law violation. Summarize the key aspects of the case and provide an analysis of whether the best decision was reached and why?

Answer 1

Stark law :

It is a set of Federal laws , that was proposed by Stark in 1988 as " Ethics in patient referrals Act", with the purpose of regulatimg the physician self referral. Many revisions and part by part implementation had occured and the final approval has done on 2001 as phase I , 2004 ohase II and the final implementation at 2007 has has done.

The law Prohibiting the Physician's self referral of the patient, who is insured under Medicaid or Medicare , to an entity , with which the Physician had or has a financial relationship. Usually the Physicians refer the patient for DHS ( Designated health services). The breach of the ' Stark law or Physician self referral law attracts huge penalties.  

Recent Example: A case on Stark law violation happened in 2018., in which the accused Healthcare facility agreed to pay the Federal Government a sum of $ 262 million for breaching the Stark laws for many years. HMA ( Health Management Associates) have engaged in Fraudulent billings and kick back practices from 2003 to 2012 . They paid bribes to the physicians for referrals and they billed Government payers for the inpatient services, in the place of billing the out patient and low cost services , also submitted false inflated Emergency department facility fee charges to the Medicaid and Medicare .

When they are in midst of all lawsuits and criminal allegations, a Tenn, based CHS ( Community health systems ) acquired HMA and they tried the various ways of settlements with the Federal Government. At last CHS agrred to pay a sum of $ 262 million for the sake HMA to the Government . Also HMA signed  for a non prosecution agreement with the Justice department . As HMA and CHS , bith cooperated in the investigation , the Government also agreed not to charge criminal offences. They cooperated completely with the Government to reveal all the kick backs happened from 2003 to 2012. At last the settlement of case was done on by paying the compensation of $ 262 million to the Government by CHS, for it's subsidiary group HMA. CHS divested the formal entity of HMA , with which it was affiliated, the ' Carlisle Regional' in 2017.