HCCA CHC - Stark & Anti Kickback Questions and Answers well Explained Latest 2024/2025 Update 100% Correct.

Stark Definition: Immediate Family Member - Spouse, natural or adoptive parent, children or siblings, step-siblings, in-laws, grandparents/grandchildren. Anti-Kickback Statute (AKS) - Prohibits anyone from purposefully offering, soliciting, or receiving anything f value to generate referrals for items or services payable by any federal health program (Medicare, Medicaid, Tri-Care). 42 states and D.C. have their own AKS. After discovering Stark Law non-compliance... - put a bill-hold immediately. AKS Definition: Remuneration - 1. anything of value 2. "in-cash or in-kind" 3. Paid directly or indirectly ex: cash, free goods, discounts, below market rent, relief of financial obligations AKS Elements - 1. Remuneration 2. Intent + Offered, paid, solicited or received 3. Knowingly and willfully 4. To induce or in exchange for federal program referrals AKS Exceptions/Safe Harbors - 24 exceptions created by OIG. Must meet all conditions to qualify. Ex: investment interests, space rental, equipment rental, sale of practices, referral services, discounts, warranties, employees, etc. AKS Fines/Penalties - Administrative - Monetary penalty up to $50,000 per violation and assessment of up to 3 times remuneration. Discretionary exclusion. Brought by OIG. AKS Fines/Penalties - Criminal - Felony, imprisonment up to 5 years and fine up to $25,000. Mandatory exclusion for participating federal health care programs. Brought by the DOJAKS OIG Advisory Opinion - Party may request advice on the law concerning 1) remuneration within the meaning of the law 2) whether they are meeting one of the law's exceptions or safe harbors, or whether their arrangement warrants the imposition of a sanction AKS Revisions - - AntiKickback Statute Highlights - 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 Examples of exception - Office Spaces and Equipment Leasing - Must be in writing, space/equipment must not exceed what is reasonable and necessary and must be exclusively used by lessee. Term must be at least one year. Rental charges must be set in advance and consistent with fair market value. Rental charges may not take into account referrals or other business generated between the parties. Must otherwise be commercially reasonable. Exceptions - All Exceptions have detailed criteria; all criteria must be met for an exception to be used. Stark - Bona Fide Employment Relationships - Employment must be for identifiable services, remuneration must be consistent with fair market value, commercially reasonable Stark - Non-monetary compensation - 42 CFR 411.357(k) - Compensation from an entity in the form of items or services (not including cash or cash equivalents) that does not exceed an aggregate of $392 (for 2016). This has to be tracked. Only way to fix a dis-allowance period is to go back and ask the provider for a check for the non-monetary compensation that was wrongfully provided. Stark 3-step analysis - 1. Is there a referral from a physician for a DHS?2. Does the physician (or immediate family member) have a financial relationship with the entity providing the DHCS? 3. Does the financial relationship satisfy an exception? (ex: written contract in place) Stark Definition: Designated Health Services - Clinical lab services, physical therapy, outpatient speech pathology, occupational therapy services, radiology services, including MRI, CT and ultrasound services, radiation therapy services and supplies, DME, paternteral/enteral nutrients, equipment and supplies, home health services, prosthetics, orthotics, outpatient prescription drugs, inpatient and outpatient hospital services