There Are Several Exceptions to the Ethics in Patient Referrals

question 39

Multiple Choice

There are several exceptions to the Ethics in Patient Referrals Act and its amendments (the Stark laws) , which prohibit a physician from referring Medicare or Medicaid patients for certain designated services or supplies provided by entities in which the physician has a financial interest. Consider whether the situations described below qualify as exceptions to the Stark laws: Situation A: Dr. Wong is a physician in the Marvel Health Plan's provider network and has a financial relationship with Marvel arising from the health plan's compensation for his services. Marvel is not a prepaid health plan. Situation B: Dr. Ryder is a physician in the provider network of the Glen Health Plan, which is not a prepaid health plan. In situations of medical necessity, Dr. Ryder refers Glen patients to a physical therapy clinic that leases office space from him. Situation C: Dr. Yost has a compensation arrangement with a health plan for providing health services under the Medicare+Choice program. An arrangement that is exempt from the Stark laws is described in

• A) All of these situations
• B) Situations A and C only
• C) Situation B only
• D) Situation C only

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Definitions:

Target Return

A financial goal specifying the desired rate of return on an investment or business venture.

Scenario B

A specific potential or planned situation, often used in planning processes to test different strategies or outcomes.

Competition-oriented

A focus or strategy that emphasizes understanding, responding to, and leveraging the competitive landscape in a market.

Loss-leader Pricing

A pricing strategy where a product is sold at a price below its market cost to stimulate sales of more profitable products or services.