As I research more extensively into the complexities of healthcare law, the significance of the Anti-Kickback Statue (AKS) and the Stark Laws become increasingly apparent in the need for adaptive regulatory measures to protect against healthcare fraud. Both laws are meant to uphold the legal parameters for ensuring financial incentives do not jeopardize or interfere with patient care. The AKS originated during the early legislation phases of the Social Security Amendments of 1972, when the first federal efforts were introduced to limit fraud with healthcare transactions. Penalties were implemented in connection with the provision of Medicaid/Medicare under the Social Security Amendments of 1972. Shortly following the identification and law implementation of the AKS, Stark Laws was enacted in 1972 under the same Social Security Act of 1972 and is a statute which makes it illegal to knowingly and willingly offer, pay, solicit, or receive renumeration for referrals for services covered by federal healthcare programs. While both laws share similarities, I will explain the difference between the two laws and how they have been challenged in real life scenarios and what can be done in healthcare to abstain from violating these laws
The Stark Law is also known as the “Physician Self-Referral Law” and was officially passed in 1989 as part of the Omnibus Reconciliation Act of 1989 (COBRA). The first phase known as ‘Stark I’ initially applied only to how physicians and laboratories work together. The law was designed to address the concerns of physicians referring to laboratories on an incentive basis. This led to a conflict of interest due to overutilization of services and acting for a financial benefit rather than placing the patient’s best interest first. The second phase, ‘Stark II’ came about during an expansion in the early 1990’s and expanded the scope of the original law to include a broader range of “delegated health services” (DHS). This would include radiography, medical equipment and devices, as well as physical therapy services to name a few. Stark II demonstrated there may an impact on patient care when certain financial relationships exist.
The AKS and Stark Law provide crucial insights for both the legal and ethical framework for governing the best healthcare practices while highlighting the critical balance between legal compliance and ethical responsibility. These laws have evolved significantly over the decades, reflecting the complexities of the ever-evolving healthcare system. The need to protect the healthcare industry, specifically federally implemented programs employed under the Affordable Care Act from fraud has become increasingly challenging. The increase in fraudulent claims and practices has led to a larger deficit in the deliverance of quality, trustworthy healthcare.
Unfortunately, people are becoming increasingly intelligent on ways to commit fraud and physicians are not void of the infraction. Learning these laws opened my eyes up to things that I have witnessed at past places of employment which may have been unlawful. I prefer to work for an employer who provides professional and ethical care to all their patients. There are ‘gray areas’ to consider when defining what a ‘financial relationship’ is. For example, I knew a dentist who would send all of his oral DNA testing to one laboratory. We often received incentives from this laboratory office to include lunches and premium samples of dental supplies. I cannot say for sure if it was intentional, but it is safe to say if there is any incentive or monetary reward for referring a patient to an outside source to redeem Medicaid benefits would be a question of concern. When in doubt, moving forward I would want to be educated on what legal relationships we share and how specific laws apply to our given functions.
Unfortunately, people are becoming increasingly intelligent on ways to commit fraud and physicians are not void of the infraction. Learning these laws opened my eyes up to things that I have witnessed at past places of employment which may have been unlawful. I prefer to work for an employer who provides professional and ethical care to all their patients. There are ‘gray areas’ to consider when defining what a ‘financial relationship’ is. For example, I knew a dentist who would send all of his oral DNA testing to one laboratory. We often received incentives from this laboratory office to include lunches and premium samples of dental supplies. I cannot say for sure if it was intentional, but it is safe to say if there is any incentive or monetary reward for referring a patient to an outside source to redeem Medicaid benefits would be a question of concern. When in doubt, moving forward I would want to be educated on what legal relationships we share and how specific laws apply to our given functions.