HCCA CHC - Stark & Anti Kickback QUESTIONS WITH COMPLETE SOLUTIONS

AntiKickback Statute Highlights correct answer: 1. Criminal/Civil (you go out of business 2. Any federal health program (Medicare, Medicaid, Tri-Care) 3. Requires proof of improper intent (DOJ-Criminal) 4. Applies to any referral source 5. 24 Safe Harbors 6. OIG Advisory Opinions Stark Highlights correct answer: 1. Civil only (no prison time) 2. Medicare only 3. Strict Liability (does not consider knowledge or intent. if X happens, then you are held liable regardless of intent.) 4. Must be a physician and entity in the mix 5. Exceptions 6. CMS Advisory Opinions Stark Law Enforcement correct answer: 1. CMS 2. HHS-OIG (Does not enforce, but reviews Stark Violations to see if there is a kickback) 3. DOJ (only enforces false claims act, predicated on Stark/Tainted Referral) Stark Law 42 USC 1395nn correct answer: Non-compliance period is known as the 'disallowance period." No billing of Medicare or patient during disallowance period/non-compliance period. Any co-pays during this time also need to be returned. After discovering Stark Law non-compliance... correct answer: put a bill-hold immediately. Stark prohibits correct answer: A physician from making a referral of a Medicare Patient to an entity that furnishes 'designated health services' (DHS) if the physician has a financial relationship with the entity, unless an except applies.