Ukuxilongwa Nokunakekelwa Kwahlukaniswa Nemithi Abahlinzeka Ngayo Imithi
Imithetho yokukhwabanisa kwezeMpilo ikhona ukuze kuvinjelwe ukuxhashazwa kwezimali kweziguli. Ikakhulukazi, umthetho we-Stark usetshenziselwe ukuvimbela ukuzithumela okuzondeza odokotela ekulimazeni labo abakhathalelayo. I-Stark Law ithonya kanjani umkhuba wokulala umuthi? Thola ukuthi iziqondiso zivimbela kanjani ukuhlinzekwa kokubili ukuhlolwa kokuhlola kanye nokuphathwa kwe- apnea yokulala ezigulini ezihlanganiswe nezinhlelo zokunakekelwa kwezempilo zikahulumeni ezifana neMedare and Medicaid.
Imithetho Ikhona Yokuvimbela Ukukhwabanisa
Ukuze kuvinjelwe ukuhlukunyezwa nokukhwabanisa kweziguli ezisezintweni zabahlinzeki babo bezempilo, ohulumeni bezombusazwe nezombuso e-United States bathathe imithetho ethile. Enye yezokuqala, eyaziwa ngokuthi i-Federal False Claims Act, ibuyele esikhathini seMpi Yombango. Imithetho yokulwa ne-anti-kickback ikhona ukuvimbela noma yimuphi umuntu ekukhokheleni noma ekutholeni imali noma ezinye izinto zokubaluleka kokudluliselwa kwesevisi yezempilo. Kusukela ngo-1989, uMthetho we- Stark uye wavimbela ukuzimela ngabodokotela futhi lesi simiso singathinta ukwelashwa kwe-apnea yokulala.
Uyini Umthetho Oqinile?
Ngokwemigomo yalo elula, umthetho we-Stark uvinjelwa odokotela ukuba bangabhekiseli iziguli zabo ezinhlanganweni lapho odokotela (noma imindeni yabo eseduze) banobunikazi noma enye inzalo. Ngezinye izikhathi kuthiwa yi-Stark self-referral law.
Lo mkhawulo uthinta izinsizakalo zezempilo ezikhethiwe, kodwa kuphela uma lezi zinsizakalo zibuyiselwa yi-Medicare, i-Medicaid, noma olunye uhlelo lokunakekelwa kwezempilo, njengeTricare (esetshenziselwa abasebenzi basezikhali ezihlomile).
Lo mthethonqubo wesifundazwe kanye nezifunda eziningi ziye zachaza imithetho efanayo echaphazela ukubuyiselwa kwemikhiqizo noma izinsizakalo ngokusebenzisa izinhlelo zomshuwalense wezempilo okhokhelwa uhulumeni. Kwamanye amazwe athi, ngisho nokuzithumela kweziguli ezizimele-ezikhokhelwayo kuya ezinkampanini ezidokotela kungase kungabi mthethweni uma kunesimiso sokuvuselelwa esingahlanganiswa nhlobo.
Lezi ziqondiso zibuyekezwe izikhathi eziningana kusukela ziqala. Ngonyaka ka-2008, amaCenter for Medicare and Medicaid Services (CMS) akhiphe isitatimende esithinta ukuhlinzekwa okuhlanganyelwe kokuhlolwa kwe-apnea yokulala nokuphathwa kwayo, kuhlanganise nokukhishwa kwe- positive apk pressure (CPAP) kanye nemishini yomsindo .
Lesi sibuyekezo sivimbela ukuhlanganiswa phakathi komhlinzeki wokuhlola wokulala kanye nomphakeli we-CPAP. I-CMS ikholelwa ukuthi kukhona amandla okuzimela emkhakheni wokuhlola uma kunesisusa sokuhlola kaningi kunalokho okudingekile ngokwempilo futhi ukuhumusha umphumela wokuhlola nge-bias ethanda ukwelashwa okubuyiselwe. Njengalokhu, noma yimuphi umuntu noma inkampani ayikwazi ukwenza zombili izinsizakalo zeziguli ezihlanganiswe uhlelo lokunakekelwa kwempilo kahulumeni.
Ngenxa yalolu shintsho, i-CMS yamukele ukuvinjelwa okukhethekile ukukhokha lokhu okuzokwazi ukuhlukunyezwa ngo-2008. I-Medicare ayikwazi ukukhokhela umhlinzeki wezokwelapha ohlala njalo (DME) we-CPAP uma umphakeli enesibambisene nomhlinzeki wokuhlolwa okulele lapho ukutholakala kwe-apnea yokulala yenziwa. Lokhu kuhlanganiswa kubhekisela kunoma yiluphi ubudlelwano phakathi kwamaqembu anesibambiso noma ubunikazi.
Ngakho-ke, umuntu akakwazi ukukuhlola kokubili i-apnea yokulala bese ekuthengisela idivayisi ye-CPAP futhi abe ne-Medicare akhokhela. Nokho, njenganoma yikuphi umthetho, kukhona okunye okuhlukile.
Izinsiza ezihlanganisiwe, akuzona zonke izivivinyo
Okokuqala, kufanele kuqashelwe ukuthi lokhu kuvunyelwa okukhethekile kokukhokha kusebenza kuphela ekuhlolweni kwe-apnea yokulala ekhaya . Uma isiguli sithola i- polysomnogram yokuhlonza , senziwa njengesifundo sokulala ebusuku esikhungweni sokuhlola, ukuvinjelwa akusebenzi, noma ngabe ukuhlanganiswa kwezezimali kukhona. Kwabaningi, umthelela omkhulu kuMthetho we-Stark ukuhlinzekwa kwezinto ze-CPAP nemishini yomlomo yokwelapha ukuphefumula kokuphefumula.
Ngaphansi kwemithetho yase-US Yokudla Nezidakamizwa, i-CPAP iyinhlangano yezokwelapha enqunyiwe ehlukaniswa njengento yezokwelapha ezihlala njalo. Lezi zinhlamvu ezibalulekile zibalulekile ekusetshenzisweni komthetho kahulumeni kanye nenhloso yokubuyisela umshwalense.
Imishini ehlanganiswe nokuvinjelwa komthetho we-Stark ihlanganisa:
- I-CPAP namadivayisi we-bilevel
- Masks
- Ukuhlambalaza
- AmaHumidifiers
- Amakamelo amanzi
- Izihlungi
- Imishini yomlomo
- Ukwelashwa kwe-oksijeni
Odokotela, odokotela bamazinyo, nabanye abahlinzeki bezempilo bangase bangabhekisi isiguli kumhlinzeki we-DME uma lowo muntu (noma umndeni wakhe) unentshisekelo yokutshala izimali noma isinxephezelo-uma umphakeli ecela ukukhokha into evela ohlelweni lokunakekela impilo kahulumeni. Ngokweqile, udokotela akakwazi ukunikeza i-CPAP kwisiguli ngaphakathi kwehhovisi lezokwelapha kulo mongo.
Ukuqonda umthetho we-Stark ngokusebenzisa amacala
Ake sicabangele ambalwa amacala ukuthi umthetho we-Stark ungathinta kanjani ukwelashwa kwe-apnea yokulala:
- Umuntu osomabhizinisi uyaqaphela ukuthi i-apnea yokulala yinto evamile nokuthi ukubuyisela impahla ye-CPAP kwenza inzuzo yebhizinisi engase ibe nenzuzo. Unquma ukwakha inkampani ezokhipha imishini yokuhlola i-home sleep apnea. Uma ukuhlolwa kulungile, njengoba kuchazwa udokotela obuthongo obuqinisekiswe yibhodi, uzothengisa noma yi-CPAP enqunyiwe noma izixhobo zomlomo ngokuqondile kwisiguli. Ngeshwa, umthetho we-Stark uvimbela ukubuyisela kunoma iziphi iziguli ezihlanganyela ohlelweni lokunakekelwa kwezempilo. Lezi ziguli kuzodingeka zikhishwe.
- Umlingiswa ongathandeki uzama ukuhlela uhlelo lokusebenza azungeze uMthetho we-Stark. Uhlola iziguli, kodwa utshela labo abane-Medicare ukuthi i-CPAP yabo ngeke ihlanganiswe nomshuwalense wabo. Ufuna ukuba bakhokhele imishini ephuma ephaketheni, yize bebengaba nenzuzo uma beya komunye umhlinzeki we-DME ozimele. Iziguli zihamba lapho zihamba ziya komunye umhlinzeki, futhi zifaka izikhalazo eziholela esenzweni somthetho ngokumelene naye.
Ukungahambisani noMthetho we-Stark kanye nezigwegwe
Kubalulekile ukuqaphela ukuthi uMthetho we-Stark awusebenzi kuwo wonke umshuwalense, ikakhulukazi kubanini bomshwalense abakhokhelwayo noma ngokuzikhokhela.
Kukhona futhi okungase kube khona ngabanikezeli bezindawo zasemaphandleni njengoba izinsiza ezingahle zibe khona ngenxa yezinhlinzeko ezingekho emthethweni. Esikhundleni sokujezisa iziguli ngenxa yokuntuleka kokufinyelela, odokotela bangakwazi ukunikeza i-CPAP iziguli zabo ngaphakathi ehhovisi elifanayo.
Kunezinhlobonhlobo zezijeziso ezitholakalayo lapho abahlinzeki bephula umthetho we-Stark. Izinkokhelo zinganqatshwa futhi ukubuyiselwa kwemali kungalawulwa ngenani eliqoqwe ngokwephula umthetho. Ngaphezu kwalokho, izijeziso zomphakathi ezifika ku-$ 15,000 ukuze isicelo ngasinye esingavunyelwe singacwaningwa. Uma udokotela ezama ukuvimbela umthetho ngesilungiselelo esiphuthumayo, isigwebo sezimali somphakathi sifinyelela ku-$ 100,000 kuhlelo ngalunye.
Izwi elivela
Le mithetho ikhona ukuvikela iziguli ezinhlobonhlobo ezingenangqondo ezingathatha imali ngenani labantu abasengozini. Abahlinzeki abaningi abangekho ukwenza inqwaba esheshayo futhi baziphathe ngezindlela zokuziphatha ukuze bakhonze iziguli zabo. Ngeshwa, lezi zimingcele zomthetho zingadingeka ukujezisa labo abangafaka iziguli zabo kuqala. Kungase kube khona ushintsho olwengeziwe emthethweni, kodwa uma uzizwa sengathi uthathwe inzuzo, finyelela eHhovisi loMhloli WezeMpilo eMnyangweni wezeMpilo wezeMpilo eNingizimu Afrika ngokubiza (800) 447-8477.
> Imithombo:
> I-American Academy Yokulala Imithi. IKomiti Yezezimali YeSenate ibheka ukubuyekezwa koMthetho we-Stark. " Ngo-July 14, 2016.
> Brown, DB. "Ukulala Nokusebenza Kwemithi Yezokwelapha Ukulala-I-United States" Ezimisweni Nemikhuba Yokulala , ehlelwe nguKryger, MH et al . Elsevier , edition 6, 2017, iphe. 670-674.
> " Amasevisi weMediare and Services Medicaid. Imithi yokukhwabanisa nokuxhashazwa, ukutholakala nokubika ." Agasti 2014.
> "Ihhovisi le-Inspector General. Umgwaqo wendlela odokotela abasha: imithetho yokukhwabanisa nokuhlukunyezwa." September 2017.
> I-Staman J. "Imithetho yokunakekelwa kwezempilo kanye nokuhlukunyezwa kwempilo ethinta i-Medicare ne-Medicaid: ukubuka konke ." (Congressional. Bika No. RS22743). I-Washington DC: I-Library of Congressional Research Service, ngo-Septhemba 8, 2014.