What is fee splitting in dentistry?
Fee splitting occurs when one healthcare provider pays the percentage of a patient's fee to another healthcare provider, typically for a referral. If a specialist treats your patients in your office, you may only collect from the specialist the fair market value for the space, equipment, staff and supplies used.
What is AKS in healthcare?
The Anti-Kickback Statute (AKS) is defined as an anti-corruption statute that prohibits financial transactions that reward referrals for products and services reimbursed by healthcare programs sponsored by the federal government of the U.S.
What are exceptions to the Stark Law?
Some exceptions to the Stark Law include but are not limited to the following: Rental of office space. Rental of certain equipment. Bona fide employment relationships. Physician recruitment.
What is the difference between the Stark Law and the AKS?
The Anti-Kickback Law covers referrals for all services from anyone including physicians or pharmaceutical companies. Conversely, the Stark Law is for referrals from physicians only and covers a set list of “Designated Health Services” (DHS).
What does AKS stand for Azure?
Azure Kubernetes ServiceAzure Kubernetes Service (AKS) simplifies deploying a managed Kubernetes cluster in Azure by offloading the operational overhead to Azure. As a hosted Kubernetes service, Azure handles critical tasks, like health monitoring and maintenance.
What are the three components of quality of care?
Effective – providing evidence-based healthcare services to those who need them; Safe – avoiding harm to people for whom the care is intended; and. People-centred – providing care that responds to individual preferences, needs and values.
What are 5 factors that identify quality healthcare?
External environment refers to the environment surrounding healthcare organizations that affects their performance and quality of services.Patient socio- demographic variables. ... Patient cooperation. ... Patient illness (severity of illness) ... Physician socio- demographic variables. ... Physician competence (Knowledge and skills)More items...
How is quality defined in healthcare?
Quality is defined by the National Academy of Medicine as the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.
What are Physician Referrals under Stark?
For purposes of Stark, the term “physicians” includes: doctors of medicine (MD), doctors of osteopathy (DO), doctors of dental surgery (DDS), doctors of dental medicine (DMD), doctors of podiatric medicine (DPM), doctors of optometry (OD), and chiropractors (DC).
What is a referral for Stark?
In order for Stark to apply, a physician must make a referral. In general, Stark broadly defines the term “referral” to include a request by a physician for a DHS payable under Medicare or Medicaid. The definition of referral includes the request by a physician for consultation with another physician and any test or procedure ordered ...
What Happens if Stark has been Violated?
Stark prohibits physicians from making referrals that violate Stark and it also prohibits the entity that receives any prohibited referrals of DHS from presenting claims to Medicare or Medicaid for those services.Pen alties for violating Stark can be severe and include denial of payment, refund of payment, imposition of a $15,000 per service civil monetary penalty and imposition of a $100,000 civil monetary penalty for each arrangement considered to be a circumvention scheme.
What happens if you violate Stark?
If a legal analysis reveals that Stark has been violated, the parties have 60 days to either return the overpayment to Medicare and Medicaid or submit a self-disclosure to CMS pursuant to the self-referral disclosure protocol. We are experienced in assisting clients with the self-disclosure process.
What is Benkoff Health Law?
Benkoff Health Law is highly experienced in guiding clients with respect to which Stark exception (s) should be used in a given situation to meet our clients’ business and legal needs.
How to contact Reesa Benkoff?
If you have any questions regarding Stark or state self-referral laws, please contact Reesa Benkoff at (248) 482-2780 or through our website.
What are the three concepts of Stark's ban on physician self referral?
Three main concepts of Stark’s ban on physician self-referral include: (1) physician referral; (2) DHS; and (3) financial interest. All three concepts must be implicated in order for Stark to apply to a given situation. Stark is what is known as a strict liability law, which means that the parties’ intent to violate the law is not considered ...
What are the laws of Stark?
While federal Stark and anti-kickback laws, and state law equivalents (often known as “mini-Stark” and “fee-splitting prohibitions”) are very complex, there 5 key legal rules you’ll want to know. Think of these as The Five People You Meet in Heaven —only you meet them on Earth, and they don’t teach you about love or forgiveness or sacrifice ...
How much did Intermountain pay for Stark?
According to an article in Modernhealthcare.com entitled, Intermountain to pay $25.5 million to settle Stark case, the health system reportedly “characterized the violations as ‘technical in nature’ and said they arose partly because of the 300 pages of federal regulations and commentary that govern financial relationships between hospitals and physicians. “
Can a physician present a claim to a third party?
Where DHS are involved and the referral is prohibited, the physician may not present a claim to any third-payer for the same.
Can a physician refer a patient to a DHS?
The federal self-referral statute (“Stark”) provides that if a physician (or immediate family member) has a financial relationship with an entity, then, unless the arrangement qualifies for a specific exception: The physician may not refer patients to the entity for “designated health services” (“DHS”) payable by federal health care programs ...
Does PORA apply to healthcare licensees?
PORA applies to healthcare licensees. Even if none of the designated health services in the statute are being provided, then the prohibition is inapplicable; however, a disclosure of the financial interest must be provided to patients at the time of the referral.
What is the Stark Law?
The Stark Law is primarily a strict liability statute. This means that if an arrangement does not meet all of the requirements of an exception, the Stark Law has likely been violated. It is important to remember that a “referral” of a “designated health service” is required for an arrangement to implicate the Stark Law.
What is a referral under Stark Law?
A referral under the Stark Law is extremely broad. For example, it can be a request by a physician for an item or service, a request by a physician for a consultation with another physician, or the mere establishment of a plan of care. Thus, any referrals extending from those examples would likely be considered a referral for Stark Law purposes.
What is the penalty for violating the Stark Law?
Another lesser known civil monetary penalty that can occur for a Stark Law violation is the circumvention civil monetary penalty. In short, if an arrangement is created and developed for the purpose of circumventing the Stark Law, there could be a $100,000 penalty in addition to any other penalties.
How much did the Stark Act settle?
In any event, the Stark Law has resulted in settlements nearing $100 million and is certainly a law that healthcare organizations focus on. The following is a list of 20 Stark Law Facts: The Stark Law or Stark Act is also known as the Physician Self-Referral Law; however the name of the law comes from a United States Congressman named Peter Stark.
How many categories of health services are there in the Stark Law?
In actuality, there are 10 different categories of designated health services that are applicable to the Stark Law. One of the only Stark Law definitions that implicates a knowledge requirement is the indirect ownership interest definition.
Is there an exception to the Stark Law?
Oddly enough the Stark Law contains an exception that is solely specific to Puerto Rico. The exception relates to ownership or investment in hospitals by physicians in Puerto Rico. No other exception under the Stark Law specifically mentions a geographic location as a part of the specific requirements.
Does the Stark Law apply to a doctor?
If neither of those are a part of an arrangement, the Stark Law is not implicated. The Stark Law only applies to physicians. By Federal definition a physician is a MD, DO, DDS, DPM, Optometrist, or Chiropractor. The Stark Law does not apply to Nurse Practitioners or other Advanced Practice Nurses.
What is the importance of the Stark law?
Anti-Kickback statutes (AKS) and Stark law are extremely important issues in health care. Violations of these laws yield harsh penalties. Yet, many healthcare professionals have little to no knowledge on the details of these two legal beasts.
What is the difference between AKS and Stark?
One other important aspect of Stark is that is considered “strict liability,” whereas AKS requires a proving of a “knowing and willful” action.
What is AKS in health care?
Other than Medicare and Medicaid, AKS applies to any health care plan that utilizes any amount of federal funds. For example, AKS applies to Veterans Health Care, State Children’s Health Programs (CHIP), Federal Employees Health Benefit Program, and many other programs with federal funding.
Does the Stark Law apply to Medicare?
The general and overly broad response is that the Stark Law, 42 USC § 1395nn, only applies to Medicare and Medicaid. The AKS, 42 USC § 1320a-7b (b)),applies to any federal healthcare program.
