Loading...

Messages

Proposals

Stuck in your homework and missing deadline? Get urgent help in $10/Page with 24 hours deadline

Get Urgent Writing Help In Your Essays, Assignments, Homeworks, Dissertation, Thesis Or Coursework & Achieve A+ Grades.

Privacy Guaranteed - 100% Plagiarism Free Writing - Free Turnitin Report - Professional And Experienced Writers - 24/7 Online Support

Health and policy classmate responses

13/10/2020 Client: sathvik2009 Deadline: 24 Hours

In your responses, agree or disagree with the original poster's recommended policy changes and explain position. What suggestions do you have to improve the effectiveness of the original poster's recommendations?


Post #1 :


Maureen Calnan posted Oct 12, 2020 4:01 PMSubscribe


For any physician, it is vital to have an understanding of federal fraud and abuse laws  The laws that apply to physicians include the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL).  Violation of any of these laws could result in criminal penalties, civil/monetary fines, exclusion from the Federal health care programs, and/or revocation of the physician’s medical license (DHHS, n.d.).  The situation outlined here has the potential appearance of a kick-back scheme and my open Dr. Stevens as well as the primary care physicians to civil or criminal penalties or even loss of their license.  A kick-back is payment to someone for facilitating a beneficial relationship or transaction.  There is even potential for these actions to constitute fraud if the referrals are not for patients with a legitimate need for the services of Dr. Stevens.  The situation with Dr. Stevens also could represent a conflict of interest and could be subject to conflict-of-interest disclosure policies, even if the relationships between Dr. Stevens and the PCPs are not illegal.



  • As head of risk management for the medical group that employs Dr. Stevens, I would take an objective look at the situation to determine whether there were kickbacks, fraud, or a conflict of interest involved.  In order to obtain the additional information needed to determine if there is a legal risk to Dr. Stevens, the medical group, or the hospital, I would ask the following questions:

    • Do you give Christmas gifts to all physicians who refer patients to you or just certain ones?  If it is only certain ones, how do you determine to whom you give gifts?

    • What percentage of your business comes through referrals from these physicians?

    • To your knowledge, do these physicians refer patients to other orthopedic surgeons, or just to you?

    • What is the value of the gifts?  Are they token gifts such as a box of chocolates or are they pricy, extravagant gifts like vacations or expensive jewelry?

    • Have you ever performed – or has a patient ever accused you of performing- surgeries or procedures that were unnecessary or more extensive than required?  




The answers to these questions can help determine whether the Christmas gifts are simply small tokens of appreciation for a colleague or if they represent a conflict of interest, a kick-back, or even fraud.  I would also advise the providers in the practice to consider these questions whenever they consider giving a gift to a colleague.  In addition, I would tell them that if they ever find themselves questioning their actions, they should reach out to the legal team for advice.  I would also tell them that if they are ever uncertain about whether their actions represent a conflict, they should ask someone.  They could also use the “newspaper test” – if they would not  want the arrangement to appear on the front page of the newspaper, there is likely a conflict.


Reference


U. S. Department of Health and Human Services: Office of the Inspector General (n.d.).  A Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud and Abuse. https://oig.hhs.gov/compliance/physician-education/roadmap_web_version.pdf


Post #2 :


Rachel Watson posted Oct 12, 2020 8:08 PMSubscribe


Providers who agree to participate in government-funded healthcare programs, such as Medicaid and Medicare must agree to and follow many regulations and policies set in place to provide care and receive reimbursement for care. As head of risk management recently learning about the actions of Dr. Stevens and gift giving behaviors, my first thought is quid pro quo and Stark Law. Federal regulations through the Anti-kickback Statute prohibits giving or receiving of gifts in exchange for referrals; however, some exceptions are allowed (Fremgen, 2016). Gifts of reasonable value are typically allowed, yet not strict definition of ‘reasonable’ is found. Under Stark Law, or the physician self-referral law, referrals are prohibited between providers in which a financial relationship is established and unfortunately in this case, giving and receiving gifts can be considered as a financial relationship. A limited exception of up to approximately $300 per calendar year in unsolicited nonmonetary gifts is permitted given the gift does not violate the anti-kickback statute (Fremgen, 2016). Either way, this situation warrants more research, investigation and questions to be answered. 


Some of the questions I would like to have answers to are as follows:



  • What is the monetary value of the gifts being given? And are their gifts being received by Dr. Stevens as well?

  • What is the correlation between providers receiving gifts and the number of referrals sent to Dr. Stevens? Statistically, are more referrals being received by providers receiving gifts?

  • What is the amount of referrals the gift receiving providers are referring to other providers besides Dr. Stevens?

  • Why send gifts to certain providers and not all?

  • I would also speak with the gift receiving providers and inquire whether Dr. Stevens has offered any other form of cohersion to obtain referrals. 


For future office procedures, I would recommend instilling a no-gift policy across the board. This will eliminate any opportunities or perceptions of quid pro quo or favoritism and abolish gifts to create lawful or ethical disputes for the organization. The exception to this policy would be organization or office holiday parties in which a strict gift-giving amount is pre-determined and set and participation is completely voluntary. If any questions or concerns are raised regarding the policy, all communication is directed to the organization legal department to decipher legalities of potential issues or conflicts.




References


Fremgen, B. F. (2016). Medical law and ethics (5th ed.). Pearson.

Homework is Completed By:

Writer Writer Name Amount Client Comments & Rating
Instant Homework Helper

ONLINE

Instant Homework Helper

$36

She helped me in last minute in a very reasonable price. She is a lifesaver, I got A+ grade in my homework, I will surely hire her again for my next assignments, Thumbs Up!

Order & Get This Solution Within 3 Hours in $25/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 3 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 6 Hours in $20/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 6 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

Order & Get This Solution Within 12 Hours in $15/Page

Custom Original Solution And Get A+ Grades

  • 100% Plagiarism Free
  • Proper APA/MLA/Harvard Referencing
  • Delivery in 12 Hours After Placing Order
  • Free Turnitin Report
  • Unlimited Revisions
  • Privacy Guaranteed

6 writers have sent their proposals to do this homework:

Writer Writer Name Offer Chat

Writers are writing their proposals. Just wait here to get the offers for your project...

Let our expert academic writers to help you in achieving a+ grades in your homework, assignment, quiz or exam.

Similar Homework Questions

How many colors in a bag of skittles - Http www magickeys com books patrick index html - Blake mouton managerial grid test - Buy taylor swift concert tickets - Interpreting skewness and kurtosis in spss - Army cadet 1 star syllabus - Weightlifting is a waste of time summary - Smu google squared data & analytics programme - Exceptional Assignment Writing Service UK - Failure mode and effects analysis nursing - Ionic equation for magnesium oxide and hydrochloric acid - Copyright 2002 by incentive publications inc nashville tn answers - Words with horizontal lines of symmetry - School catchment area peterborough - Cleft chin dominant or recessive - Townley grammar sixth form - Add provider to hicaps terminal - Ibc 2015 handrail extension - Cubby investments pt liverpool - Modigliani and miller - Heinz dilemma answers - Routers and routing basics pdf - The duality of nature - Tv network ownership chart - Jacana energy check my bill - Olet psychology of crime - Uq college tertiary preparation program - Strategic staffing process - Discussion 1 250 words by 08/26/ 2020 at 2:00 pmplease add references and citations - Olga is the proprietor of a small business - Please respond --->if you can complete in 12 hours - Apollo greek god family - What is installed when you choose the rsat-dfs-mgmt-con feature? - Unit viii table of dirty tricks - Malcolm x learning to read answers - Report Writing Paper - Biology - Case of the lovers gamble - Apa citation for the belmont report - The data selected to create a chart must include - Monocular depth cues accommodation - Wakefield intermediate care unit - Exeter uni accommodation office - 2 papers - Recognise healthy body systems pdf - Mona lisa golden ratio - Plato's allegory of the cave ted talk - Law of cosines derivation - Change readiness assessment survey - Australia net international investment position - U.S Health care delivery system - Engineering graduate cover letters - Why do firms use cross border strategic alliances - Word module 1 sam project 2 - Language techniques in lord of the flies - Comprehensive problem 2 tj's specialty shop answers - MIS437 lab activity - Legal point of discharge maroondah - Scope management plan template - Pmi recently renamed project time management to project ____ management - Social work intake interview questions - Case study toms shoes - Register of approved occupational clothing with ausindustry - In the following mrp planning schedule for item j - Festool domino supplemental manual - Discussions 3 - A cat came fiddling - Aircraft safety wire procedures - International Business - Bitcoin economics research paper - Immediate skill shortage list nz - Interest Rate, Stock Valuation, Risk and Returns - Separating mixtures worksheet grade 6 - Harvest home road reserve - Shaver manufacturing inc offers dental insurance to its employees - Discussion - SUPPLY AND DEMAND - Cost of capital case study - 2 bedroom basement for rent in surrey near scott road - Community psychology linking individuals and communities 3rd ed pdf - Because you loved me movie - Bahrain garden of eden - Second nature a gardener's education summary - Rhetorical devices practice worksheet - Discussion 1: Measuring Consciousness - Laaperi v sears - What is merge activity in project management - The open window by hector hugh munro - Windhoek mines ltd of namibia is contemplating - Is the practice of tailoring products and marketing programs - Discussion - Examine the genetic code table, shown below. the codon agc codes for the amino acid ______. - PP1 - Character description of oliver twist - Studies in social power - Nostalgic ceramics stoke on trent - When you re an addams - Worcester boiler fault a21 - Download the file below - Ops 571 week 6 signature assignment