Maintaining Compliance with Stark, HIPAA, JCAHO, and Other Healthcare Related Oversight Organizations

Compliance

HIPAA

HIPAA is the Health Insurance Portability and Accountability Act, and is one of the primary pieces of legislation for keeping patient information secure and confidential. Healthcare providers deal heavily with protected health information (PHI) and need to keep HIPAA compliance as one of their forefront priorities. Within HIPAA are the privacy rule and security rules, which at their essence are designed to ensure that information stays safe under physical, electronic, technical, and administrative safeguards.

JCAHO

The Joint Commission on Accreditation of Healthcare is an organization designed to maintain high standards of quality in healthcare. While JCAHO has no legal enforcement power, JCAHO accreditation still does communicate strongly that the healthcare organization takes high standards seriously. “A facility which has completed the JCAHO accreditation process can then include the JCAHO logo and accreditation information in their company literature.”

Medicare and Medicaid Anti-kickback statute

“Congress originally enacted the Anti-Kickback Statute as part of the Social Security Amendments of 1972. Until then, only one provision sanctioned false claims and misrepresenting facts to the government, and the limited language impeded efforts to prosecute Medicare and Medicaid fraud, according to a Journal of Law and Health article.

Despite the addition of the Anti-Kickback Statute, Medicare and Medicaid fraud and abuse continued to rise, according to the Journal of Law and Health. In 1977, the Medicare-Medicaid Anti-Fraud and Abuse Amendments increased the penalty for violating the statute from a misdemeanor to a felony to discourage further fraudulent activity.

To cut down on Medicare and Medicaid fraud and abuse, including Anti-Kickback violations, HHS and the Department of Justice also created the Health Care Fraud Prevention and Enforcement Action Team, commonly referred to as HEAT, in 2009. Healthcare fraud became a Cabinet-level priority with the creation of HEAT.

As is stands today, the consequences for violating the Anti-Kickback Statute today are steep. Criminal penalties can include fines up to $25,000 and a five-year prison term per kickback while civil penalties can cost as much as $50,000 per kickback in addition to three times the amount of damages sustained by the government. Violators can also be excluded from federal healthcare programs.” (http://www.beckershospitalreview.com/legal-regulatory-issues/20-things-to-know-about-the-anti-kickback-statute.html)

Stark Law compliance

The Stark Law is a provision within the Omnibus Budget Reconciliation Deficit reduction act that regulates self-referrals within the healthcare industry. From starklaw.org: “this provision is known as “Stark I”. The law included a series of exceptions to the ban in order to accommodate legitimate business arrangements. A number of observers recommended extending the ban to other services and programs. The Omnibus Budget Reconciliation Act of 1993 (OBRA 1993) expanded the restriction to a range of additional health services and applied it to both Medicare and Medicaid; this legislation, known as “Stark II,” also contained clarifications and modifications to the exceptions in the original law. Minor technical corrections to these provisions were included in the Social Security Amendments of 1994.”

BBA of 1995

On November 20, 1995, Congress gave final approval to the conference report on the Balanced Budget Act (BBA) of 1995. President Clinton vetoed the measure on December 6, 1995. BBA included several amendments to the physician self-referral provisions. The two major changes were the repeal of the prohibitions based on compensation arrangements and the reduction in the list of services subject to the ban.

Contract Management Software

The many different types of contracts related to the medical field, all of which need to meet regulatory requirements and maintain a certain degree of compliance, can create a difficult and tedious situation to navigate. To make handling these types of contracts easier, more secure, more simplified, and more intuitive than ever before, use the Concord Contract Success Platform. With Concord, you can perform e-signatures and e-negotiations, as well as review, share, and edit contracts from literally anywhere with an internet connection, anytime.

Please feel free to give us a call at 844-693-7446 to learn more about how Concord can be used to manage your medical contracts and agreements.