Prepare for the Business of Healthcare and Health Policy Test. Study with multiple choice questions and explanations to ace your exam!

Multiple Choice

Which law prohibits self-referrals?

Stark Law, the Physician Self-Referral Law, directly targets the practice of a physician referring patients for designated health services to an entity with which the physician has a financial relationship. It applies when Medicare or Medicaid payment is involved and uses strict liability—intent isn’t required to violate it—so referrals can be illegal even if there’s no bad motive. The rule exists to prevent conflicts of interest and overutilization, ensuring referrals are based on patient need rather than financial ties. Designated health services include things like radiology, pathology, and laboratory services, among others; if a physician owns or has a compensation arrangement with a facility and then refers patients there for such services, the referral can violate the law unless a specific exception applies. The other laws mentioned address related concerns but in different ways: the Anti-Kickback Statute bars paying or receiving kickbacks to induce referrals, HIPAA covers privacy and security, and the False Claims Act targets fraudulent claims for payment.

Stark Law, the Physician Self-Referral Law, directly targets the practice of a physician referring patients for designated health services to an entity with which the physician has a financial relationship. It applies when Medicare or Medicaid payment is involved and uses strict liability—intent isn’t required to violate it—so referrals can be illegal even if there’s no bad motive. The rule exists to prevent conflicts of interest and overutilization, ensuring referrals are based on patient need rather than financial ties. Designated health services include things like radiology, pathology, and laboratory services, among others; if a physician owns or has a compensation arrangement with a facility and then refers patients there for such services, the referral can violate the law unless a specific exception applies. The other laws mentioned address related concerns but in different ways: the Anti-Kickback Statute bars paying or receiving kickbacks to induce referrals, HIPAA covers privacy and security, and the False Claims Act targets fraudulent claims for payment.