Legal Standard Project
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School
Clarkson College *
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Course
HM495
Subject
Medicine
Date
Apr 3, 2024
Type
docx
Pages
6
Uploaded by olubunmiayanfe
Legal Standards Project
1.
You are the new practice manager for Meadow Pediatric Care, a pediatric primary care group owned by Dr. Charles Greene. Meadow Pediatric Care serves a large Medicaid population. As you review policies, you find that all referrals for speech-language pathology services are made to Children’s Speech and Language Services of Valley View (CSLSVV), which is one of three area businesses that supply those services to children. As it happens, your sone has had services from the CSLSVV, and you know that the business is owned by Dr. Greene’s sister, Dr. Sherry Watt.
1. What could this discovery mean for Dr. Greene? Apply the appropriate federal statute. To what corrective action might he be subject?
2. Upon further investigation, you find that a monthly deposit is being made from CSLSVV into the pediatric groups account. What could be inferred from this transaction and what federal statute would apply? To what penalties might Dr Greene be subject?
3. Could the term “safe harbor” have any relevance in this scenario? Justify your answer.
1.
Discovery of referrals to family members business:
The Federal Statutes that may be applicable to this scenario is the Anti-Kickback Statutes with the following implications for Dr. Greene:
Medicaid is a federal healthcare program. Anti-Kickback statutes prohibit the exchange of anything of value to reward the referral of federal healthcare program business.
Dr. Greene's referrals to his sister's business may be considered a violation of the AKS.
Corrective actions may include fines, exclusion from federal healthcare programs, and potential imprisonment.
2.
Monthly Deposit from CSLSVV to Pediatric Group's Account:
The Federal Statute that prohibits physician self-referral for certain designated health services is
the Stark Law. The following are the likely penalties:
If CSLSVV, owned by Dr. Greene's sister, is making deposits to the pediatric group's account, it could suggest financial arrangements between the entities.
If these transactions involve referrals for designated health services, it may violate Stark Law.
Penalties for Stark Law violations may include fines, repayment of amounts collected, and potential exclusion from federal healthcare program.
3.
Relevance of “Safe Harbor”: safe harbor regulation protects certain payment and business practices that could potentially implicate AKS from criminal civil prosecution if the necessary requirements are met (Brodnik et.al, 2017). The following are the relevance of safe harbor in this scenario:
If Dr. Greene's referrals to his sister's business meet the conditions of a safe harbor, it
may provide protection against AKS violations.
However, safe harbors are specific and must be strictly followed to provide protection.
If the financial transactions between CSLSVV and the pediatric group do not fit within a safe harbor, the AKS violations may still be applicable.
Overall, the discovery of referrals to Dr. Greene's sister's business and financial transactions between the businesses raises potential legal and ethical concerns. Dr. Greene could be subject to penalties under the Anti-Kickback Statute and the Stark Law. The application of safe harbors depends on whether the arrangements meet specific conditions outlined in the law.
2
.
As the HIM Director, you have been served with a subpoena to produce records for an upcoming court case. Your release of information clerk is new, and when you direct her to the procedure to follow for preparing records in response to a subpoena, you find there is none. What steps should you include in the procedure? Elements of a valid subpoena must be verified which includes:
The name of the court from which the subpoena was issued
The caption of the action (name of the plaintiff and the defendant)
Assigned case docket number (to validate the case)
Date, time, and place of requested appearance
The information required, such as testimony or the specific documents sought in a subpoena duces tecum
The form in which that information is to be is to be produced
The name of the issuing attorney
The name of the recipient being directed to disclose the records
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The signature or stamp of the court/official or judge authorized to issue the subpoena (Reynolds 2010)
After verifying the validity of the record,
I think it is important to document the receipt of the subpoena including the date and time it was received,
Inform the appropriate personnel within the organization, such as legal counsel, about the receipt of the subpoena,
Compile the requested record, making sure to include all relevant documents within the designated time frame,
Inform legal counsel once the records have been compiled and released,
Ensure secure and documented delivery of the records to the requesting party, maintaining a record of the delivery date and method,
Follow up with legal counsel or the requesting party as needed, and maintain documentation of any responses or further actions taken,
Regularly review and update the procedures based on changes in laws or regulations to ensure ongoing compliance.
It is also important to train the staff in subpoena response. Provide ongoing training to staff, especially those involved in releasing information, about the proper procedures for responding to subpoenas (Brodnik et.al, 2017).
3.
Looking at the discharge summary, the patient is 74-years-old female with different health conditions. She was admitted because of infected right hip prosthesis and discharge home
to selfcare. Considering her age and condition, I think it would have been better if she was discharged to a nursing home or assigned a nurse to her because it was never mentioned in the discharge summary if she has any family member living with her. She was also discharged with 5 other diagnosis which makes self-care not advisable for her. She is also an active smoker as at the time of admission, compliance with quitting smoking might also be difficult since she has no one around. It was not mentioned in the discharge summary too if a therapist was assigned to her. For her age and her conditions, selfcare is not advisable at all.
References
Anti-kickback statute and physician self-referral laws (stark laws
)
. American Society of Anesthesiologists (ASA). (n.d.). https://www.asahq.org/quality-and-practice-
management/
managing
-your-practice/timely-topics-in-payment-and-practice-
management/anti-kickback-statute-and-physician-self-referral-laws-stark-laws Fundamentals of law for Health Informatics and Information Management. (2017). American Health Information Management Association.
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