Modification

1. Hello to Everyone: this is oral presentation of
a Group Project that never get to be
presented.
I, Modupe Sarratt invented a fictitious
Hospital called Layman Hospital System
(LHS) for the group project. The name of the
hospital is to simplify healthcare system in
which a layman will understand the laws that
Group Project Modification
By
Modupe Sarratt

2. Roles
As a moderator for my colleagues, I will introduce our group as the
speakers and the concept each speaker is going to present for their part.
The speakers
Speaker One, will speak on
…..Slides 3-7 for the role of compliance officer & the type of case report to
the Board of Director
Speaker Two, my part, I will speak on
…..Slides 8-18 to explain Stark Laws and Anti-kickback Statute and how the
law differ
Speaker Three, will speak on
…..Slide 19-22 to speak about corporate integrity agreement and
compensation agreement
Speaker Four, will conclude
…..Slide 23-25 with answering the specific question for reference

3. By
Speaker One
THE ROLE OF A COMPLIANCE OFFICER
FOR LAYMAN ORGANIZATON HOSPITAL
SYSTEM (LOHS)

4. The role of compliance officer
 The health compliance officer has critical role in
healthcare institutions.
 They are mandated in the creation of the
compliance committees to ensure that the health
standards are followed with a disciplinary
directive which are well known to anyone
 They are also concerned with solving problems of
individuals who have been sanctioned.
 Mandated to act as a liaison between
management and the board of directors thus
playing a critical role in making decisions on the
kinds of policies the institution is going to take
(Mifsud, 2014).

5. What are your duties as a
compliance officer?• Duties of a compliance officer include, but
are not limited to implementing the standards
that will reflect compliance with the Office of
Inspector General’s (OIG) and enforcing the
policies for the daily operation of an
organization.
• When developing a compliance plan for a
medical practice, there are seven fundamental
standards of an effective compliance program
that reflect the principles of the Office of the
Inspector General’s (OIG)
• The seven fundamental standards
according to Reding (2013) include:
(Reding, 2013).

6. 1. Ethics and Procedures: these include risk analysis of medical
coding, medical record, medical documentation, billing services and
physician practices for patient evaluation and management (E/M).
2. Designating Responsibility: mainly falls on the administrator to
educate other employees, updating physicians’ licensure, and reviewing
physician practice for standard of care
3. Train and Educate Employee: requires compliance education for all
staff for continuing education.
4. Monitor and Audit: Requires an infrastructure for the patient privacy,
the privacy of health record for E/M code and CPT Code.
5. Anonymous Communication Lines System: having a systems for
reporting misconduct, abuse, and fraudulent activity.
6. Responding and Enforcement with Disciplinary Action: a
process for investigating noncompliance to the standards of care for a
sanction or a termination for violation of procedures, standards, rules and
laws.
7. Conducting a Dialogue: the purpose of conducting a dialogue is to
“narrow down limitation or deficiency in the organization operations” that
can be used to improve guidelines for an effective communication an
organization (Krisco 1999).
The Seven Fundamental Standards By
(OIG):

7. Type of case report to the Board
Of Directors (BOD)
The type of case for reporting is the Halifax, a public health system on Florida’s east
coast, paid $85 million to the Department of Justice after a federal judge ruled that
contracts between Halifax and its medical oncologists violated the Stark Law (Sigo,
2014). The Stark Law forbids a hospital from billing Medicare for certain services
referred by physicians who have a financial relationship with the hospital. In addition
to the $85 million, Sigo states that the hospital entered a corporate integrity
agreement,” obligating itself to undertake certain reforms and to have federal health
care claims reviewed for the next five years.” for a debate to create a new bill/law

8. By
Speaker Two
Modupe Sarratt
Stark Law (SL)
& Anti-Kickback Statue (AKS)

9. What is the Stark Law?
The Stark law is named for United States
congressman, Pete Stark, who sponsored the initial bill
(Stark, 2013). Stark law is a set of United States
federal laws that prohibit physician self-referral.
The law governs physician self-referral of
Medicare and Medicaid patients for financial link,
specifically a referral of a Medicare or Medicaid to an
entity providing designated health services (DHS) if
the referring physician or his family member has a
financial relationship with the entity (e.g, a physician
cannot refer a Medicare patient to a hospital where his
or her spouse is a surgeon) It is a violation of the law
if a physician or an immediate family member of the

10. Continuation for what is the Stark Law?
 The Stark law prohibits the institution from
billing Medicare and Medicaid or third party or
some other institution for the provided service
due to self-referral.
 It implemented in stages as Stark II & III.
 Stark II when the intermediate family
member of the physician has financial links or
tie to a particular organization for self-referral.
 Stark III deals with malpractices in the
healthcare sector with self-referral practices of
doing each other a favor.

11. Who does the stark law pertain to
exactly?
The law pertaining to the physicians who refer
Medicare and Medicaid patients for specific
services or designated health services for
having a financial relationship or referring
patients for doing a favor. Physician self-referral
according to Stark (2013),
 is the practice of a physician referring a
patient to a medical facility in which he has a
financial interest, be the ownership, had
investment in the organization, or a
structured organization for compensation
arrangement.

12. Agencies providing the Stark laws
 Many federal agencies are responsible for the
provision of Stark law;
 these include the Department of justice, the
Department of health and human services, and
the Center for Medicare & Medicaid Services
 However, patient protection act and affordable
care act contact for eligibility provided
amendments for other agencies by the state, the
state of Maryland has Healthcare connection for
the affordable care act.

13. What is Anti-Kickback Statute
(AKS)?
 AKS is a criminal law that prohibits the exchange or offer to exchange of
anything value in effort to induce or for a reward to referral
Medicare/Medicaid patient for health care services. It is a criminal offense
to privatize or trade federal health care program (Medicare or Medicaid)
for financial gain. Knowingly and willfully referral the Medicare/Medicaid
patient for health care business is considered fraud and abuse of federal
health care program.
 The AKS is a law passed by the American Congress, by which it is illegal
for all types of healthcare providers –physicians included –to intentionally
and consciously take bribes with Federal healthcare programs (e.g., using
generic drug for brand name, using federal supplies or resources for
Medicare/Medicaid for a specialist)
 According to Kusserow (1991) the Medicare and Medicaid anti-kickback
stature “makes it a crime to knowingly and willfully offer, pay, solicit or
receive reimbursement in exchange for the referral of federal programs
for a business (p49).
 It forbids any recommendation or arrangement for the requesting of
any service paid by a federal health care scheme.
 It can also mean that, accommodating payments for referrals not
from Medicare or Medicaid transaction is as against the law for

14. The videos by Ryan et.al (2011) and Rabin (2014) tell
the difference between Stark Laws and Anti-kickback
stature.
Stark Law Anti-Kickback Statute
Stark Law is typically part of settlements stemming from
federal health care program investigations. In exchange for
the establishment of the CIA finding of false claim, the OIG
will not take actions excluding the provider and/or entity
from participation in federal health care programs such as
Medicare or Medicaid.

15. How does Stark Law differ from the
Anti-Kickback Statute?
 Differ in terms of:
 prohibition
 penalties,
 Exceptions
 federal health
programs
 Referrals
 items/services,
 intent,

16. This video by Holland & Hart LLP (2015)
explain the consequences for violating the
either the stark law or the anti-kickback statute

17. Explaining the differencesProhibition: the Anti-Kickback Statute prohibits offering,
paying, soliciting, or receiving anything of value to reward
referrals of Federal health care program for doing business.
The Stark law prohibits physicians from referring patients for
designated health services or to an entities with which the
physician has a financial relationship.
Penalties: the Anti-Kickback Statute include criminal
offense, civil liability, and ethics violation/misconduct
combined for penalties; anti-kickback statute is the punishment
for violating standards and breaking the rules. The Stark Laws
carry only civil penalties for ethical violation or the violating of
standards (OIG, n.d.).
Exceptions: voluntary safe harbors are allowed in the
Anti-Kickback Statute for not all misconduct or unethical
behaviors break the law.
Whereas the Stark Laws carry mandatory exceptions for
violation of standards/ethics.

18. Continue with Explaining the
difference
Federal Health Programs: the Anti-kickback statute
applies to all programs. The Stark law applies to only
Medicaid and Medicare physicians self-referral practice
Referrals: the Anti-Kickback Statute prohibits referrals
from anyone. The Stark law prohibits referrals from physicians
Items or services: the Anti-Kickback Statute prohibits any
items or services. The Stark Law prohibits designated health
care services
Intent: for the Anti-Kickback Statue, unlawful intent has to
be demonstrated for making profit by unlawful means such as
overcharging for procedure or receiving overpayment from
doing favors, an intent to gain financially by unlawful action
or violating ethics to receive bribe for participating in the
event such as, physicians self-referral practices.
The Stark Laws have no intention to violate standard although
intend to deceive or damage for advantage is considered a

19. By
Speaker Three
Can the board of directors be held
personally liable for Stark and/or Anti-
Trust violations?

20. Corporate integrity agreement
 In violation of the Anti-Kickbacks statute for corporate
liability. An agreement can be negotiated with the
provider of the health care or even within the
organization itself.
 According to Finegan (2006) the criminal action “can
only be prosecuted by the government.” It is part of the
corporate strategy to examine case for false claims of
the statutes; The OIG admits not to exclude the
provider or any health care facility from taking part in
the federal health care program (p. 625).
 Agreement which is negotiated with the provider of the
health care as part of the settlement strategy from
false claims of the statutes.
What is a corporate integrity
agreement?

21. Compensation agreement
 The payment sum compensated to the physician based
on the employment accord must be steady with the fair
market worth of the services offered.
 The agreement must be presented in writing .
 reimbursement under the agreement ought to be set in
prior if the employer will want the general’
What is a Compensation agreeme

22. The board of directors
 That any case violated under the two laws that is; the
Stark and the Anti-Kickback Statue the board of
director will be held personally liable for violations if
found to have assisted or participated in procurement
and arrangement of deals with the physicians.
 They need to understand that going against the set
standards is the crime.
 It is better for them to avoid such transaction because
the penalties are very high.
 They should be role models to physicians,
 Also they should organize seminars with physicians to
offer tips on the importance of the Stark and Anti-Trust
What the Boards of directors need to
know to avoid personal liability?

23. By
Speaker Four
Conclusion

24. Was a representation of the Stark
law aim to resolve the false claims
act?
YES
False Claim Act allegations by CIA for a violation of federal
health care programs is a barred/expelled of an institution, a
closed down healthcare institution. The False Claims Act, also
called the "Lincoln Law") is an American federal law that
imposes liability on persons and companies (typically federal
contractors) who defraud governmental programs. It is the
federal Government's primary litigation tool in combating fraud
against the Government 31 U.S.C 3279- FALSE CLAIMS (United
States Code, 2006).
A corporate integrity agreement (CIA) is a “contractual
agreement between the Office of Inspector General (OIG) of
the U.S. Department of Health & Human Services, to allow an

25. References
Mifsud, M (2014). The possible role of the Chief Ethics and Compliance Officer in Maltese Financial
Institutions (Master’s thesis, University of Malta)
Stark, P. (2013). Stark Law
Sigo, S. (2014). Daytona Beach, Fla., Health System Settles DOJ, Whistleblower Case. Bond
Buyer, 1(34164), 1.
Finegan, S. (2006). The False Claims Act and Corporate Criminal Liability. Qui Tam Actions, Corporate Integrity
Agreements and the Overlap of Criminal and Civil Law. Penn St. L. Rev., 111,625
Krisco, K. H. (1999). Leadership and the Art of Conversation. Conversation as a Management Tool.
Conducting a dialogue, pp93-94. Jaico Publishing House,
Kusserow, R. P. (1992). The Medicare & Medicaid Anti-Kickback Statue and the Safe Harbor
Regulations—what’s next? Health Matrix, 2, 49.
Kusserow, R. (2013). Best Practices for an MCO Negotiating a Corporate Integrity Agreement. Managed
Care Outlook, 26(16), 6-8.
United States Code. (2006). Sec. 3729 - False claims Edition, Supplement 5, Title
31 – MONEY AND FINANCE