Hiring a Physician for the Emergency Room-Stark law
The Law and ethics in healthcare practice are closely intertwined (Pozgar, 2019). The Stark Law seeks to ensure physicians consider ethics when making references in their practice. The Stark Law can be violated even by intent alone (Huttinger & Aeddula, 2022). It is against the Stark Law to make referrals to an institution that is reimbursed by Medicaid and Medicare if the physician has a financial interest or relationship with the facility. Financial relationships may also include structured compensation arrangements. Additionally, the Stark Law prohibits self-referral referrals to designated health services (DHS), including radiology and any other imaging services. According to the Legal Information Institute (2021), a compensation arrangement can be defined as a structured compensation arrangement if it includes direct or indirect remuneration between a physician and an entity providing or for DHS. Therefore, in this case, the physician receiving payments from a medical imaging company for every referral he sends to the company violates the Stark Law in more than one way.
A health system that has employed or is employing a physician who has violated the Stark Law is liable for the payment of the large fines that the violation might attract (Ferry & Medlin, 2022). Therefore, it is important to investigate the physician to establish whether they did or did not violate the Stark Law. The first step in investigating the physician’s alleged violation of the Stark Law is to review the Law and its provisions related to the case. The next step is to inform the physician they are under investigation to avoid any privacy and confidentiality violations, and then follow up with the DHS on the related case for further assistance with the investigation.
References
Ferry, J. H., & Medlin, L. E. (2022). The Stark Law. Laws of Medicine, 303–311. https://doi.org/10.1007/978-3-031-08162-0_19
Huttinger, R., & Aeddula, N. R. (2022). Stark Law. Encyclopedia of Health Care Management. https://doi.org/10.4135/9781412950602.n745
Legal Information Institute. (2021, November 19). 42 CFR § 411.354 – Financial relationship, compensation, and ownership or investment interest. | Electronic Code of Federal Regulations (e-CFR) | US Law. Cornell Law School. https://www.law.cornell.edu/cfr/text/42/411.354
Pozgar, G. D. (2019). Legal and ethical issues for health professionals, 5th ed (5th ed.). Jones & Bartlett Learning.
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Your hospital is looking at hiring a physician for the emergency room. Someone reported that this physician receives payment from a medical imaging company for each referral he sends to them.
Hiring a Physician for the Emergency Room-Stark law
Is this a violation of the Stark law. Explain. What steps would you take as the hospital administrator to investigate and ensure you make the best decision for your hospital?
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