arrangements might implicate

Question Description

I’m studying for my Health & Medical class and don’t understand how to answer this. Can you help me study?

 

1. Which of the following arrangements might implicate the physician self-referral law (Stark Law)?

A) The request by a physician for a hospital service for his Medicare patient.

B) A physician referring a patient to a home health provider when the home health provider who lends the referring physician his DC United season tickets.

C) A physician sending a patient to her own practice, and specifically a nurse practitioner who performs a designated health service.

D) All of the above

2. A clinical laboratory has developed a new test that is billable to Federal health care programs, but physicians are not ordering the tests. The clinical laboratory decides it wants to start paying the physicians to order the new tests. It thinks it can make these payments through a “medical speaker program.” The amounts paid to the physicians do not represent fair market value. What, if any, laws might be implicated?

A) This has to do with physicians ordering laboratory tests, so the Stark Law would only apply.

B) Neither, so long as an arrangement makes good business sense.

C) Potentially both the Stark Law and Anti-Kickback Statute.

D) Only the Anti-Kickback Statute because the laboratory intends to reward the physician’s for their referrals.

3. A neurologist, Dr. Narci, sends every hospitalist who refers patients to his practice a custom portrait of himself. Dr. Narci mainly sees this as a way to boost his own ego, but also a nice gesture to the physicians sending him some business (and maybe more). Does this raise an Anti-Kickback Statute issue?

A) Yes, the Anti-Kickback Statute does not care about the intent of the physician.

B) Yes, one purpose of the portrait is to induce referrals.

C) No, it’s mainly for Dr. Narci’s ego so it would not implicate the Anti-Kickback Statute.

D) No, the art print is only nominal in value.

4. A physician practice wants to employ a nurse practitioner. The practice believes she will be a dynamite addition and make tons of referrals to the practice. They offer her a W-2 position with compensation that is greatly above fair market value for similarly situated nurses. Does this raise any Anti-Kickback Statute concerns?

A) So long as the nurse practitioner is providing covered items or services and is a bona fide employee, this arrangement should satisfy a safe-harbor.

B) The arrangement fails to satisfy an anti-kickback safe harbor but does not seem to violate the 3 anti-kickback statutes.

C) The arrangement fails to satisfy a safe-harbor and likely presents significant risk under the anti-kickback statute because the amount of remuneration is above fair market value.

D) None of the above

5. A home health provider was expecting the COVID pandemic to increase its revenues however, budgets have not gone to plan. The home health agency is underwater and it needs to shore up referrals for its services. It decides to compensate physicians who refer fifty or more Medicare beneficiaries to the home health provider in the form of providing them “Medical Directorships” with annual salaries of $100,000.00 for five hours of work a year (not FMV). Does this arrangement raise any Stark or AKS issues?

A) It raises a Stark issue, not an AKS issue.

B) It raises an AKS issue, not a Stark issue.

C) It raises both a Stark and an AKS issue.

D) These arrangements both appear compliant.

6. A cardiology group, which had been providing cardiology call coverage for a hospital, is looking to rent physician office space in an office owned by the hospital. Contract negotiations are underway, and the cardiology group has proposed payment of $1,400.00 per month for rent. The hospital does not have a problem paying the amount but does not want to violate any fraud and abuse laws. What might be the best practice to determine the compensation is fair market value?

A) Take an independent poll of physicians renting space in different hospitals to determine a median rent.

B) Just assume that this number is reasonable given it is within the hospital’s budget.

C) Counteroffer a price that is lower to demonstrate this is an arm’s-length transaction.

D) Engage a fair market value consultant who will be able to provide a range of potential FMV compensation for similar arrangements in the geographic area and marketplace.

Grading Rubric for Each Question

I. Selects Correct Answer (1 point)

II. Demonstrates Analytical and Writing Skills (4 points)

 Provides clear explanation for answer selected

 Identifies and explains key regulatory and compliance considerations

 Recognizes any nuances/complexities and thoughtfully addresses them

 Writing is concise, organized, and easy to understand

 Analysis is logically developed and presented

 Response is free of grammar and usage errors

 Response follows requested format

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