HLT 520 Week 4 Stark laws Discussions 

HLT 520 Week 4 Stark laws Discussions

 

HLT 520 Week 4 Discussion 1 Latest-GCU

Discuss your opinion of the Stark laws, what they are designed to do, the impact of the exceptions, and whether you think they are successful in preventing unethical behavior.

HLT 520 Week 4 Discussion 2 Latest-GCU

What kinds of fraudulent or abusive behavior relating to health care services can occur in hospital operations? How does the role of the compliance committee help to monitor and prevent these?

 

GCU HLT 520 Assignment

Details:

Scenario: You are the administrator on call for a local hospital and you receive a call at 2:00 a.m. from another local hospital regarding a patient with a broken upper arm. The ED physician’s assistant is calling to arrange an EMTALA transfer from his hospital to yours, but the orthopedic physician on call at your hospital is refusing to accept the transfer, stating that the patient doesn’t need a higher level of care. When you ask him about that, he tells you the fracture is not displaced, and can be splinted and seen in the office. The ED physician at your hospital is very nervous about the possibility of an EMTALA violation.

1) Write an analysis (1,000-1,500 words) of the situation, how it is impacted by EMTALA, and what decision you will make as the administrator, along with your rationale and thought process.

2) Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.

3) This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.

 

 

MORE INFO 

The Stark laws

Introduction

The Stark Law requires that physicians and other health care providers to report the cost of designated health services to Medicare, Medicaid, or private insurers. These laws are designed to protect patients and are in place to prevent financial exploitation. However, doctors must be careful not to overreport their charges or they may run afoul of these rules. This article will cover some key points of the Stark law as well as some general exceptions that would apply if you had any questions about the topic.

Stark law exception applies to a specific physician or group of physicians

The Stark law exception applies to a specific physician or group of physicians. It does not apply to other types of health care professionals or their practices, such as nurses and physical therapists.

The Stark law exception applies when you receive treatment from a physician or group of physicians who are not covered by Medicare (or Medicaid), your insurance plan, or an employer-sponsored plan. This means that if you receive services from these individuals—and they charge for them—you must pay for them out of pocket.

Full time requirement, financial relationship

A physician must work full-time in his or her primary practice. The Stark law defines this as practicing medicine for more than 80 hours per week, but less than 120 hours per week.

A financial relationship between the physician and the hospital or health system is necessary for a physician to be paid under the Stark law. This means that you must have a close personal or professional relationship with your employer such as being an employee there or having them pay part of your salary if they do not have a contract with another company that does so (like an HMO).

The amount of time spent working full time varies depending on what type of practice you are in and whether you are employed by an HMO instead of directly by an employer like most private practices do today—it’s usually around 50% more than 60 hours per week (which is still considered “full time”), but sometimes even more!

Fair market value, commercial reasonableness, only one patient per day

The Stark laws are a set of laws that regulate the use of medical services by non-physicians. They were established in order to prevent physicians from engaging in unnecessary treatment or procedures, so their patients would not have to pay for them out of pocket. In other words, if you don’t need a doctor’s care, then you should not go see one—and if you do need care from a physician, then he or she will be regulated by these same rules.

The Stark laws also apply to other professionals who provide health care services like dentists and chiropractors: they can only treat one patient per day (or less), which means they’ll have an incentive not to over-treat their patients as well!

Written agreement and signature

If a written agreement is not signed by both parties, it is not valid. A written agreement must contain the following information:

• Date of signature

• Name or names of the physician(s) or group of physicians involved in the treatment or care being provided to your child/ward.

This information must be dated and signed by both parties (parent/guardian and treating physician).

Retroactive changes may lead to Stark violation and liability

You may have heard that the Stark law is complicated and there are many exceptions. In fact, you can be liable for violating the Stark law if you make a retroactive change to an existing contract. If this happens, consider consulting with an attorney before signing any documents related to your business or personal affairs.

General exceptions for designated health services.

Designated health services are those that are covered by a state’s Medicaid program, and they include:

• Medical services (like doctors’ visits)

• Mental health services (such as counseling for depression)

• Substance abuse treatment like substance abuse treatment centers and inpatient detoxification programs.

Conclusion

There are several exceptions to the Stark law that cover the practice of medicine. These exceptions apply to doctors who have a full time practice or who are working for a group of physicians that share an office space. If a doctor is working in an office with other doctors, then all of them would qualify for these exceptions. In addition, there are also fair market value and commercial reasonableness exceptions under which the physician can charge higher prices for services provided at their office or clinic without violating the law.