What are the specific behaviors that are prohibited by the Anti-Kickback Statute?

Under the provisions of the Anti-Kickback Statute, the law prohibits the soliciting, receiving, offering, or paying any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or kind.

What is the Stark Law also known as and why is it important to hospitals?

The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.

What percentage of medical procedures are unnecessary?

Physicians reported that an interpolated median of 20.6\% of overall medical care was unnecessary, including 22.0\% of prescription medications, 24.9\% of tests, and 11.1\% of procedures.

What is an example of the Anti-Kickback Statute?

Basically, anything of value to a person in a position to refer, such as cheap office space, patients referrals, a free employee, or a fat bonus, can classify as an illegal inducement under the Anti-Kickback and Stark laws.

What is an example of Stark Law?

For example, if you invest in an imaging center, the Stark law requires the resulting financial relationship to fit within an exception or you may not refer patients to the facility and the entity may not bill for the referred imaging services.

What is the policy justification for the anti-kickback law?

At its heart, it is an anti-corruption statute designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services.

What are exceptions to Stark law?

For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements.

What are CMS guidelines for referrals?

In a CMS compliant situation, you would 1) ask for referrals without mentioning any benefit to the enrollee and then 2) present a thank-you gift for the referrals he or she has provided. Second, the gifts you provide must be of a nominal value.

Why do doctors order unnecessary tests?

Ordering unnecessary tests and scans can directly impact the quality of care administered by healthcare providers. Doctors or specialists are prevented from providing the best care they can because of the delays caused by wasteful medical testing.

Why do doctors order so many unnecessary tests?

The top two reasons the doctors ordered these tests were fear of missing something that would help them diagnose their patients, and protection against malpractice. The doctors also said that they’d welcome patients becoming more involved in the decision-making process.

What are the Stark Law exceptions?

What is Emtala regulations?

The Emergency Medical Treatment and Labor Act (EMTALA) requires hospitals with emergency departments to provide a medical screening examination to any individual who comes to the emergency department and requests such an examination, and prohibits hospitals with emergency departments from refusing to examine or treat …

Why do doctors order unnecessary medical tests?

In rare circumstances, a doctor may actually own the testing facility and may bill you or your health insurance for your medical test. This can be a motivation for some doctors to order unnecessary tests in their own facilities. Overtesting costs money.

Can a doctor Bill you for an unnecessary medical test?

In rare circumstances, a doctor may actually own the testing facility and may bill you or your health insurance for your medical test. This can be a motivation for some doctors to order unnecessary tests in their own facilities.

Do ER doctors order too many tests?

Now, a new survey of emergency room doctors suggests why. Of the 435 ER physicians asked about the tests they order for their patients, more than 85\% admitted that in general, they call for too many tests, even if they know the results won’t really help them decide how to treat their patients.

What happens if you have too many medical tests?

Having too many medical tests can provide you with a false sense of security, allowing you to believe that you are completely healthy when you really just had normal results on unnecessary tests. Another effect is that excessive radiation exposure is not considered safe, and can increase your risk of disease.