CHC Study Q Healthcare Compliance Certification Stark & Anti-Kickback

Question Answer
What is the Anti-Kickback Statute? Prohibits ANYONE knowingly & willfully who offer, give, solicit or receive any remuneration (directly or indirectly, in cash or kind) in return for referring an individual or arranging a service reimbursable by ANY federal health care program
Is the Anti-Kickback Statute criminal or civil statute? Both criminal and civil
What federal healthcare programs are regulated Anti-Kickback Statute? All federal healthcare programs via OIG
What makes the Anti-Kickback Statute a criminal statute? Because the Anti-Kickback Statute requires proof of improper intent, a felony upon coviction.
Who files charges for violation of the Anti-Kickback Statute? The Department of Justice (DOJ)
What are criminal penalties under the Anti-Kickback Statute? Fined up to $25,000. Imprisoned not more than five years; or Both
What are civil penalties under the Anti-Kickback Statute? Up to $50,000. per violationUp to 3 times the amount of kickbackExclusions from participation in ALL federal health care programs & possible False Claim Act penalties.
What are Safe Harbors under the Anti-Kickback Statute? Described as agreements that are safe from prosecution that meet an exception criteria per the statute
What are the Anti-Kickback Statute safe harbors? Practitioner recruitment, investment interest, group purchasing, space rental, equipment rental, sale of practice, discounts and ambulatory surgical centers.
What is the Stark Statute? If a DR(or immediate family member) has a direct or indirect financial relationship with an entity that bills MEDICARE, the DR cannot make referrals to facilities who provided Designated Health Services unless the relationship fits w/in an exception
Is the Stark Statute a criminal or civil statute? Civil only
What federal healthcare programs are regulated by Stark Statute? Medicare & Medicaid only via CMS
What kind of statute is the Stark Statute? A strict liability statute (The imposition of liability on a party without a finding of fault. You only have to prove that the violation occurred and that the defendant was responsible.
Who has to be involved to be guilty of violating the Stark Statute? There must be a PHYSICIAN and an ENTITY involved.
What are Designated Health Services (DHS)? Are hospital inpatient and outpatient services, diagnostic radiology services and clinical laboratory services
Name three examples of Stark Statute exceptions? Rental of office space equipment, personal services and non-monetary compensation
What does the stark Rental of office space equipment agreement exception cover? It covers payments by lessee to lessor for the use of the office space; the agreement must be for a term of at least 1 year, signed, details space and purpose and the cost is of fair market value. Agreement does not consider volume or value of referral
What are some problems re: stark statute Rental of office space equipment agreements? No agreement, changes in space w/o amendment, expired leases, no/late signatures, uncollected rent, non-exclusive use, enforcement of late charges, not FMV, rent does not include all services.
What is an stark exception for late signatures for agreements? If inadvertent, must be completed within 90 days of the agreement being non-compliant. This can only be used by the same physician once every 3 years,
What does the stark personal services exception generally cover? Call coverage, medical director agreement, medical staff leadership agreement, professional services agreement and/or any service agreement.
What must the stark personal services exception agreements include? Remuneration from an entity to a Dr. if agreement is in writing & specifies all services covered by Dr., at lest for a term of 1 year, never expires but complies w/ all other exceptions including compensation is set in advances, is FMV, no VVRs.
What are some problems re: stark statute personal services agreements? No K, Comp/services different than K, Commercial reasonableness, 2X payments, Dr. documentation, missing/late signatures
What does the stark statute non-monetary compensation exception cover? Compensation to unemployed Drs. in the form of items & services that does not exceed the annual amount assigned by CMS.
What are the stark statute non-monetary compensation exception requirements? The items/services does not count VVR, not solicited by Dr. or family member, does not break law, it is not cash/cash equivalent & does not exceed the allowed yearly limited. Annual dollar requirement excludes one appreciation event for all Drs. a year.
What are some stark statute non-monetary compensation exception problems? Lack of reporting of items/services provided to each unemployed Dr., Not tracking/monitoring the cost for all items/services provided, determining the cost of item/service provided
What happens if you exceed the annual limit for the stark statute non-monetary compensation exception? Any cost value above the allowed annual limited must be returned to the Dr. w/in 180 days it was given &/or no later than the last day of the calendar year. Only allowed per Dr. once every 3 yrs.
What is stark statute period for dis-allowance ? The period when the referrals & Medicare claims & referrals are not permitted, excluded from Medicare program.
What are civil penalties under the Stark Statute? Refund overpayment to CMS, civil monetary penalties up to $15,000 per each claim & up to $100,00 per arrangement, Exclusion from federal healthcare programs, & possible False Claim Act penalties.

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