Online Signature Lawfulness for Healthcare in United States - Simplify Document Signing Process

How to eSign a document: online signature lawfulness for Healthcare in United States

what's up beautiful people in this video i'm going to be teaching you everything that you need to know about healthcare fraud and healthcare abuse this video will touch on the four high-yield laws slash acts slash statutes which show up commonly on the ethics questions on usmle and comlex if you like my channel and want to support my mission to provide free medical education please consider clicking the join button or clicking the first link in the description of any video on my channel when you sign up to be a dirty medicine member you support the channel financially by paying 4.99 a month to help the channel grow and to support my mission of providing free quality medical education i really appreciate your consideration so in this video we're going to be talking about the four things that you see on this slide these are the healthcare fraud and healthcare abuse laws we're going to pay particular attention to the stark law anti-kickback statute false claims act and exclusion statute now when it comes to usmle and comlex there's not a whole lot of legal stuff or legal jargon that you need to know but since these are acts statutes slash laws specifically related to health care abuse they are increasingly more high yield because test writers want to know that the physicians training today will be competent and ethical enough to know what would be considered a violation of these acts so we're going to go through these one at a time it's going to be sort of rapid review kind of just drive by talking about each of them quickly and individually and i'll point out what you need to know for examination purposes so let's start with the stark law the stark law is basically a set of laws that prevents physicians from having financial relationships with any health care entity if the physician has a financial stake in that entity so the way that you could think about this is let's say that you go out there and you become a vascular surgeon and vascular surgeons make a lot of money so you've got all this cash coming in and you're like huh i gotta invest this and you invest in a surgery center or a surgical center what you cannot do ing to the stark law is refer your patients to that surgery center because you have an ownership stake in it you can see that this is very clearly a conflict of interest and it's prevented in the stark law now i want to point out that this applies not only to physicians that have their own financial relationships with a healthcare entity but it also applies to their family members so if your wife is a lawyer and doesn't even work as a physician but she has an ownership stake in some health care entity such as a sergey center you still can't refer your patients there so that's the stark law now a little bit of healthcare history here originally the stark law only applied to lab services so like you know blood draws but it's since been expanded and now the catch-all phrase that they use is designated health services so physicians cannot have any financial they can't refer patients to any designated health service if they have or if their spouse or family member has a financial stake in that entity so designated health services or dhs includes things like any type of therapy so physical therapy occupational therapy etc outpatient medications imaging radiology inpatient services home health care it's basically a term that's intended to be a catch-all phrase and the bottom line of the stark law is that doctors who have an ownership stake in something cannot refer patients to that something and it doesn't matter what it is so this is the stark law the next piece of legislation we need to talk about is the anti-kickback statute now a lot of people confuse stark law and anti-kickback but they're actually different so anti-kickback statue is a criminal law which prevents physicians from receiving kickbacks or anything of value in exchange for referring patients to services that are reimbursable by federal healthcare programs so we're focusing on medicare and medicaid here see my video on insurance medicare and medicaid if you need more clarification about what those programs are but the bottom line is that the anti-kickback statute basically says that if you're going to refer a medicare medicaid or other federal health care patient to some health care entity you cannot have made that referral as a result of a quote kickback which is basically anything of value so for example if you're considering where to send a patient to in terms of a skilled nursing facility you cannot refer a patient to a skilled nursing facility if that skilled nursing facility is paying you to do so as you can see that is a major conflict of interest because now you're referring the patient to receive some level of care or some health care service which will be billed to medicare or medicaid those are federal health programs you're doing all of that in exchange for a kickback in this case a dollar now of note i want to point out because it's very high yield it doesn't just have to be money the exchange or the kickback could be anything of value so if the skilled nursing facility was like yo doc send us all your patience we'll give you a bunch of lamborghinis i don't know why they suddenly have a jersey accent but yo doc we're gonna give you a lamborghini send us all your patience that would be a violation of the anti-kickback statute because in exchange for cars which is the kickback you're making the referral and as you can see patients trust your healthcare judgment so when you're a physician if you make referrals to different healthcare services the assumption is that you're doing that in the best interest of the patient but when the kickback is introduced and the physician is being paid money being given cars being given expensive trips all inclusive stays with beautiful filet and lobster dinners these all violate the anti-kickback statue last high yield thing that i do want to point out which you see is the last point on this slide something that shows up on exams a lot is that waiving co-payments is actually a violation of the anti-kickback statute so you cannot waive co-payments for patients in federal healthcare programs you can't do it it's fraud it violates the anti-kickback statute let's move on and talk about the false claims act and as the name implies here this is the piece of legislation that prohibits healthcare workers from submitting fraudulent claims hence the name false claims act and basically this has both a criminal and a civil component so under the civil component a physician can be found guilty even if there's no attempt to defraud the government which basically means if a physician bills a claim especially to a federal health care program that says i promo i performed all of these services but they didn't perform all of those services maybe they did half of it or just pieces of it but they build that they did this whole package of stuff or services that's the false claims act and that would be the civil component because in this case it's not that the physician is attempting to defraud the government they're not thinking to themselves i want to take all this money or be reimbursed all this money for services that i didn't actually perform they're just making the error in billing and then there's the criminal component which is much more serious and usually revolves around physicians who are intentionally trying to defraud the government they're submitting and fabricating all of these claims so that they can be reimbursed for services that they've never performed that's the criminal component and if healthcare workers or physicians are found guilty they can actually face pretty extensive jail time potentially have their licenses revoked so the false claims act is pretty straightforward the name tells you exactly what it aims to prevent it's preventing false claims which is basically billing for things that you either didn't do or didn't do to the extent that you said that you did the next statute that we'll talk about is the exclusion statute and the exclusion statute basically defines the ways that individuals or physicians can be banned from participating in federally funded health care programs so basically if a if medicare or medicaid has an issue with a physician maybe the physician violated one of the three laws acts or statutes that we already talked about the exclusion the exclusion statute excuse me would be the statute under which that physician could be banned from then participating further in any of those federal health care programs now this falls under the purview of the office of the expec of the inspector general i cannot talk today the oig and basically the criteria under which the exclusion statute can be enacted are any of the following so medicare or medicaid fraud obviously if a physician engages in medicare or medicaid fraud they will be excluded from participating any reported patient abuse or neglect felony convictions in either another healthcare matter or related to controlled substances so something shady happening with like opioids and stuff like that misdemeanors in other healthcare related frauds or controlled substances or violations of professionalism causing some problem with the physician having their unrestricted license so the name of this statute is exclusion statute and this is it defines the ways in which physicians could be excluded from participating in federally funded health care programs so these are the four that you need to know and i flew through them so i made this table for your studying pleasure again stark law prevents physicians from having financial relationships with health care entities if the physician or a family member has an ownership stake anti-kickback prevents kickbacks so doctors can't be given cash cars meals trips etc in exchange for referring patients somewhere false claims act prevents false claims so don't bill for things you didn't do and the exclusion statute establishes the definition under which physicians can be excluded as the name implies from participating in federally funded healthcare programs so for the most part these four laws acts statutes the name kind of tells you what you're dealing with with the exception of stark law so kind of go through them take your time re-read re-watch this video this is increasingly high yield i don't know what to tell you the epic section is only going to get harder as the tests continue to come out so know this information well because it is very high yield love you keep up the good work