Medicare, Medicaid, third-party payers. Coursework

Coursework
Author Name
Institution Affiliation
The Medicare and Medicaid Patient Protection Act of 1987 provided a detailed description of penalties for acts impacting Medicare, Medicaid, and state health services. It was made clear that any person who is involved in crimes or creates a mess for others in any way would be subject to punishment. Whoever willingly solicits remuneration and hides the facts from the officials will have to face serious consequences. This impacted the lives of various people to an extent. The aim of the Medicare and Medicaid Patient Protection Act of 1987 was to prevent criminals from accessing healthcare facilities. However, if someone feels guilty and accepts his mistake, then he will not have to pay more than $25,000 in fines. If he does not arrange the money, he may be sent to jail for over five years. The Recovery Demonstration Project was launched with an aim to access the effectiveness of Medicare and Medicaid and see how physicians and service providers are paid for their services. California, Florida, and New York were chosen for this demonstration due to their high capita Medicare and Medicaid expenditure amounts. A survey was conducted to determine how many service providers are satisfied in these states and record their responses about the RACs. Nearly 2,400 service providers participated in this survey, and the results made it clear that some changes were needed in the Medicare and Medicaid projects because not everyone was satisfied and happy with the way they were being treated or paid for their services.
Stark Law prohibits physician self-referral, most importantly referrals by the clinician or doctor of a Medicare or Medicaid patient to an entity providing designated health services. In simple words, we can say that it prevents physicians from working for Medicaid and Medicare from referring their patients to private clinics where they are likely to be charged a lot for the medications and treatment. As per the Anti-Kickback Statute (42 U.S.C. § 1320a-7b(b)), such referrals make no sense, and the doctor who is found to be doing so can be panelized, or legal action agai...