A healthcare provider’s legal obligations are vast and include several focus areas. This article will cover HIPAA, the Stark Law, the False Claims Act, and the Emergency Medical Treatment and Active Labor Act. By the end of this article, you’ll know what you need to know to avoid potential liabilities. But how do you ensure your organization’s compliance with these laws?
The Health Insurance Portability and Accountability Act, or HIPAA, governs the protection of health information that a covered entity receives from patients and transmits to third parties. While HIPAA is designed to protect the privacy of patient information, it also helps to advance individual health care practices. For example, healthcare attorney services mandate that covered entities use health information technology to improve patient care and reduce costs. The legislation establishes meaningful use standards for electronic health records, encompassing a wide variety of practices, from e-prescribing to drug allergy checks to maintaining patient diagnoses.
Regardless of size or type, all healthcare providers are considered healthcare providers. They electronically transmit health information for certain transactions, such as claims and referral authorization requests. These transactions must comply with certain standards that HHS sets forth. And don’t forget to read up on HIPAA. Keeping up to date with the latest legislation is essential for both health care providers and patients.
The healthcare industry is vast, dynamic, and full of legal complexities. As a provider, you must understand and abide by several laws pertaining to your work. In particular, you should be aware of the Stark Law, which prohibits physicians from referring Medicare and Medicaid patients to entities with financial relationships. Therefore, you will likely violate the Stark Law if your practice performs these services.
The Stark Law defines a physician’s duties as being “in the shoes” of an entity. This relationship may include ownership, investment, or compensation arrangements. It also applies to immediate family members, including spouses, parents, and children. In addition, stepparents, stepchildren, and siblings are also considered family. Generally, a healthcare provider must disclose any relationships with business associates involving financial gain.
False Claims Act
The False Claims Act (FCA) imposes several duties on health care providers, including the need to provide accurate and complete documentation of all services provided to patients. Providers must be aware of the FCA requirements, which include improperly billing government programs for services that are not offered or upcoding. These practices violate the law and can result in financial penalties for the healthcare provider.
The False Claims Act empowers whistleblowers – people inside or outside of a healthcare organization – to file a lawsuit on behalf of the government. Whistleblowers are often individuals who have discovered fraudulent practices within a healthcare organization. False claims acts are a long-standing tradition that began during the Civil War and impacted the Union Army and Lincoln’s administration. The 39th U.S. Congress enacted the False Claims Act to protect consumers from healthcare fraud.
Emergency Medical Treatment and Active Labor Act
The Emergency Medical Treatment and Active Labor Act (EMTALA) is landmark legislation governing emergency room practices. It requires hospitals to provide medical screening for all emergency room patients, including those not in the hospital or on hospital property. In addition, emergency care providers must provide stabilizing treatment and appropriate transfer for those requiring emergency care. These laws are complex and not intended to cover every aspect of a hospital’s responsibilities under the act.
The emergency department must follow the law and post signs notifying patients of their right to medical screening. Then, the physician must treat the patient until they are stable or transfer them to another hospital. If the patient is in an active labor stage, the hospital must follow the law and procedures. However, this can be difficult. However, it is possible to fulfill all EMTALA obligations as long as the patient is in a condition where a transfer is safe.
If you’re a healthcare provider, you’re probably aware of the Anti-Kickback Statute. Congress passed the statute in 1972, and it has been enhanced several times since. Under the law, offering, paying, or accepting value in exchange for referring patients is illegal. This applies to Medicare, Medicaid, and TRICARE programs. As a healthcare provider, you have a legal responsibility to adhere to the statute.
In addition to the recipients, the payers and providers of kickbacks are all subject to the Anti-Kickback Statute. The underlying principle of liability under the AKS is intent. If you’re guilty of committing a kickback, you’re liable for a maximum fine of $25,000 and up to five years in jail. You’ll also be banned from participating in Medicare and Medicaid programs.