Indlela Umthetho Omkhulu Othinta Ngayo Iziguli
Uma kuziwa emithethweni ephathelene nokunakekelwa kwezempilo, omunye wemithetho ebaluleke kakhulu futhi evame kakhulu kunzima ukuyiqonda umthetho we-Stark. Ebizwa ngemuva kokuxhaswa komthetho, ummeli wase-US uPet Stark waseCalifornia, lo mthetho uyaziwa nangokuthi umthetho wokudlulisela udokotela.
Ekuqaleni, uMthetho we-Stark wenzelwe ukuvimbela odokotela ukuba bangabhekisi iziguli ze- Medicare ne- Medicaid ukuthola ukuhlolwa okungeziwe noma amasevisi webhu uma udokotela (noma isihlobo sodokotela) enesithakazelo sezimali enkampanini eyenza ukuhlolwa.
Ukukhathazeka kwakungenxa yokuthi odokotela babekwazi ukuhleleka ukuhlolwa, noma izinsizakalo zempilo ezikhethiwe (DHS), uma bezama ukuzuza ngokwezimali ezivivinyweni ezengeziwe.
Ezinye zezinsizakalo zempilo ezikhethiwe ezithathwe yi-Stark Law zihlanganisa: izinsizakalo ze-laboratory zemithi, ukwelashwa ngokomzimba , ukwelashwa kwemisebenzi, i-radiology, imisebe kanye nempahla, imishini yokwelapha ehlala isikhathi eside kanye nempahla, i-prosthetics, i- orthotics , izinsizakalo zezempilo zasemakhaya, izinsizakalo zezempilo, izinsizakalo zesibhedlela ezingelapheki , kanye nezinsizakalo zesibhedlela ezingaphandle. Uma iziguli zidinga lezi zinsizakalo, odokotela abakwazi ukuwadlulisela ezakhiweni lapho banesithakazelo sezezimali.
Izinselelo Zomthetho Omkhulu Uqhubeka
Kusukela ekuqaleni kwawo ngo-1989, uMthetho we-Stark uvuselelwe futhi wanda. Ukubuyekezwa okwenzeka phakathi kuka-1992 no-2007, kubizwa ngokuthi u-Stark I, uStark II no-Stark III. Ngenxa yalokho, umthetho usude isikhathi eside futhi ukuhambisana nomthetho sekuyinkinga enkulu kudokotela.
Ngaphezu kwalokho, umthetho we-Stark ngumthetho obophezelekayo. Lokho kusho ukuthi inhloso yodokotela ayihloswanga lapho ihlolisisa ukudluliselwa. Ngenxa yalokho, udokotela angatholakala enecala lokuphula umthetho ngaphandle kokuhlose ukwenza kanjalo.
Ngaphansi komthetho we-Stark, Uma udokotela enza ukuhanjelwa futhi akukho okunye okushiwo umthetho, umthetho we-Stark uphuliwe.
Futhi lokhu kungaba yindleko kakhulu. Eqinisweni, odokotela bangakwazi ukukhokhiswa kuze kufike ku-$ 25,000 ngokuphula umthetho kanye nokuphindwe kathathu inani elithathwe ku-Medicare.
Ezinye izimpahla zingabandakanya ukudingwa ukubuyiselwa yonke inkokhelo eyatholwa ngezinsizakalo, i-$ 100,000 yenhlawulo yombango yokuzama ukuvimbela umthetho nokukhunjulwa kwezinhlelo zokunakekelwa kwezempilo zikahulumeni. Odokotela bangase babhekane nemithwalo eyengeziwe ngaphansi kwe-Federal False Claims Act. Umthetho we-Federal False Claims, ngezinye izikhathi obizwa ngokuthi uMthetho we-Lincoln, ngumthetho wesifundazwe obeka icala kubantu noma izinkampani eziphanga izinhlelo zikahulumeni ezifana neMedare. Lesi senzo ithuluzi eliyinhloko likahulumeni lokulwa nokukhwabanisa nohulumeni.
Abahlaziyi bomthetho we-Stark bathi ukudluliselwa kwadokotela ezinkampanini ezidokotela akuyona indawo evamile. Ngaphezu kwalokho, bathi labo odokotela abanomnikazi noma abatshale izimali ezikhungweni zezokwelapha basabela esidinga emphakathini okungenakuhlangatshezwa. Babuye balondoloze ukuthi izinkampani eziphethe udokotela ziphindwe kaningi ngezinye izindlela eziphansi.
Injongo Yomthetho Stark
Umthetho wokuqala wawungelula futhi uqondile. Inhloso yalo kwakuwukuvimbela udokotela ngokwakho ukudlulisela i-DHS lapho isiguli sasihlanganiswa noMedare noma omunye umkhokhi kahulumeni.
Ukucabanga ngukuthi udokotela we-self-referral ubonisa ukungqubuzana kwesithakazelo ngoba udokotela uyazuza ngokudluliselwa kwabo siqu.
Ngenxa yalokho, abaningi abasekela uMthetho we-Stark bakholelwa ukuthi ngaphandle kwalo, odokotela bangase bahlanganyele ekusetshenzisweni okuningi kwezinsizakalo. Lo mkhuba wawuzokwenza izindleko zokunakekelwa kwezempilo zibe khona. Ngaphezu kwalokho, bakholelwa ukuthi kuzokwenza uhlelo lokudlulisela ekuthunjweni oluzolimaza ukuncintisana ngabanye abahlinzeki.
Kukhona futhi ukukhathazeka ukuthi ngaphandle koMthetho we-Stark, ukwenziwa kwezinqumo zokwelashwa kuzogxila ezigulini zokuqondisa ezibhekene nezivivinyo nezakhiwo ezithile kunokuba ubeke kuqala isiguli nezidingo zakhe kuqala.
Lokhu kuzobe sekulimaza izinqumo zokunakekelwa kwezempilo ezenziwe futhi zibeke iziguli engozini.
Indlela Umthetho Omkhulu Othinta Ngayo Iziguli
Ngomthetho we-Stark okhona, abaningi abashushisayo bakholelwa ukuthi kugcina odokotela bengalawuli izivivinyo ezingadingekile . Ukwengeza, bathi kusiza ukugcina izindleko zezempilo ekukhuphukeni okungadingekile futhi kukhuthaze ukuncintisana ngokudambisa ukuxhashazwa kwamandla ezinsizakalo. Kubuye kuqinisekiswe ukuthi izinqumo zokunakekelwa kwezempilo azithonywanga ukuthi kungenzeka ukuthi udokotela angazuza ekuhlolweni okungeziwe.
Ngakolunye uhlangothi, abagxekayo bakhathazeka ngokuthi uma isiguli siphila emphakathini omncane futhi sidinga ukuhlolwa okuqondile lokhu kungase kubenze ngendlela engalungile ikakhulukazi uma ukhetho olulodwa luyisikhungo esinikezwa udokotela. Ezimweni ezinjengalezi, isiguli singadingeka ukushayela amamayela amade ukuze uhlolwe ngoba udokotela wakhe akakwazi ukumtshela esikhungweni somphakathi ngoba udokotela unesithakazelo sezimali kuleso sikhungo. Ngaphezu kwalokho, uma isiguli singenakho ukuhamba noma imali yokushayela kwenye indawo, angeke athole ukunakekelwa kwezempilo akudingayo. Ngenxa yalokho, uMthetho we-Stark ungafaka ezinye iziguli engozini yokungatholi ukunakekelwa kwezempilo okwanele.
Ngaphezu kwalokho, abagxeki baphinde bakhathazeke ngokuthi uMthetho we-Stark uvimbela okwamanje. Esikhathini esisodwa esilethwe phambi kweCongress, iqembu lezokwelapha lafuna ukunikeza abacebisi bezakhi zofuzo mahhala emahhovisi omsebenzi wezigodi ezizimele. Laba beluleki bazokubonisana lapho udokotela ezwa ukuthi umntwana uzokufa ngesikhathi sokuzalwa noma maduzane. Yize ngabe le nsizakalo yayizozuzisa iziguli ngokunikeza izimpendulo ezengeziwe nokuhlolwa, ngaphansi koMthetho we-Stark abacebisi bazobhekwa njengenzuzo kumsebenzi wezigodi ezizimele.
Izwi elivela
Ngokuvamile umqondo wangempela woMthetho we-Stark wawuwukuvikela iziguli ze-Medicare ukuba zisebenzise odokotela abangase bahlale bazuze ekudlulisweni kokuhlolwa. Kodwa ngazo zonke izinguquko kanye nokuguqulwa koMthetho we-Stark, sekuye kwaba nzima nakakhulu odokotela ukwazi ukuthi ngabe baphula umthetho yini noma cha. Eqinisweni, kunezinkampani eziningana zomthetho ezikhethekile ekuqeqesheni odokotela mayelana noMthetho we-Stark. Futhi kukhona ongakhetha kukho odokotela abaphula ngokungazi umthetho we-Stark.
Ngakolunye uhlangothi, kukhona odokotela abaqaphela umthetho we-Stark futhi bakhethe ukungayinaki. Uma uzizwa udokotela wakho eyala ngokuhlola izivivinyo ngenhloso yokuthi uzozuza kuzo ngokwezezimali, ungaxhumana neHhovisi loMhloli WezeMpilo eMnyangweni WezeMpilo WezeMpilo wase-United States (800) i-HHS-TIPS noma (800) 447-8477.
> Imithombo:
> "Iphepha Lomgwaqo Labalwazi Abasha: Imithetho Yokukhwabanisa Nokuhlukunyezwa." UMnyango WezeMpilo waseMelika kanye Nezinsizakalo Zabantu. https://oig.hhs.gov/compliance/physician-education/01laws.asp
> Betheze, uFiliphu. "Ngokushesha, isikhathi sokulungisa uMthetho we-Stark," I-Health Leaders Media, ngoNovemba 10, 2016. http://www.healthleadersmedia.com/leadership/quick-time-fix-stark-law
> Ellison, Ayla. "Izinto ezingu-15 zokumazi ngomthetho ophansi," ukubuyekezwa kweBergker Hospital, ngo-February 18, 2017. https://www.beckershospitalreview.com/legal-regulatory-issues/15-things-to-know-about-stark-law- 021717.html
> Gosfield JD, u-Alice. Iqiniso Eliyiqiniso Ngomthetho Oqhekekile, "i-American Academy of Family Physicians, ngoDisemba 2003. http://www.aafp.org/fpm/2003/1100/p27.html
> Higashi DC, uStephanie. "Ukungazi Akunesizathu Sokuxolisa: Ungayigqugquzeli Imithetho Ye-Stark," I-Chiropractic Economics, ngoFebhuwari 15, 2017. https://www.chiroeco.com/violate-stark-laws/
> "Udokotela Wokuzikhethela." Amasevisi we-Medicare neMediicaid Services. https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index.html