Furthermore, we cannot forge a safe harbor under 42 C.F.R. §1001.952(p), because Sundown Community Hospital is not a physician's group (Altshuler, Creekpaum, & Fang, 2008). Finally, the proposed arrangement does not fall within the safe harbor provided for investments in group practice because the hospital would not meet the criteria of: equity interests held by licensed professionals; equity interests being in the entire practice; unified business with unified decision making and pooling of financial interests; and revenues from ancillary services coming only from in-office ancillary services (Altshuler, Creekpaum, & Fang, 2008). Consequently, the proposed arrangement would fall outside of the safe harbor provisions of the Medicaid Anti-Kickback Statutes; however, the proposed arrangement may fall within the exceptions to the Stark Statute. Reviewing the Stark Statute, no physician may refer Medicare or Medicaid patients to an entity (here, the hospital) to which he/she has a financial relationship unless the transaction falls under one of the exceptions (Altshuler, Creekpaum, & Fang, 2008). The proposed joint venture does not meet any of the exceptions to the Stark Statute that might allow Medicaid/Medicare referrals, such as: ownership/investment interests and compensation arrangements; ownership only or investment interests only; compensation arrangements only. Furthermore, since the Stark Statute is a "strict liability" Statute requiring...
Their chief contribution, given the composition of their practice, would be Medicare patients and it does not appear that the proposed arrangement would satisfy the requirements of either or both statutes. An alternative might be contract that does not involve joint ownership/investment interests in which the contract clearly enunciates that the parties are not entering the agreement to induce referrals or solicit remuneration in exchange for Medicare/Medicaid referrals.
The safe harbors do not cover every area of permissible behavior, and an arrangement may not qualify as a safe harbor, but still not subject someone to the risk of prosecution. In fact, the courts have interpreted the Federal Anti-Kickback Law relatively narrowly. The court in Feldstein v. Nash Community Health Servs., 51 F. Supp.2d 673 (E.D.N.C. 1999), implied that the government has to show that a defendant knowingly intended
Assignment: Research two articles on the web that pertains to the Joint Theater Support Contracting Command (JTSCC). What are the issues or problems within the framework or process of operating the JTSCC? Give real world examples.The world is rife with conflict and disagreements. These disagreements, depending on their severity can result in war and many civilian deaths. Retaliatory efforts on the part of other countries can further exacerbate conflict causing
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Mortgage Fraud Mortgage fraud is said to occur when fabrication or omission of important facts on the part of prospective homebuyers, lenders or sellers results in the approval of mortgage loans or terms applicants would usually not be entitled to enjoy. Mortgage fraud constitutes a major transgression, potentially prosecutable and resulting in incarceration for those found guilty. According to American state and federal regulations, mortgage fraud may cause an individual to
roles of forensic accountants in preventing and detecting fraud within a business community. The paper highlights the requisites and basic responsibilities of a forensic accountant. The paper also makes references on the special cases where forensic accountants have assisted in fraud detection and prevention. Overview of Forensic Accounting Forensic accounting is the specialty area of accounting used to train an individual to develop the special accounting skills to detect and prevent
Enron could engage in their derivative trading strategy with no fear of government intervention because derivative trading was specifically exempted from government regulation. Due in part to a ruling by the Commodity Futures Trading Commission's (CFTC) chairwoman, Wendy Graham, derivatives remained free of regulatory oversight. Ms. Graham, wife of Texas senator Phil Graham, made this ruling 5 weeks before resigning as chairwoman of the CFTC and joining the Enron Board
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