Court Case

 Public prosecutors opened charges against nine surgeons after a kickback arrangement backfired. Authorities were able to salvage $950 million from the illegal kickback scheme. The $950 million belonged to California’s innocent patients in need of major surgeries. These illegalities were brought to light after the government caught wind of the plan to defraud workers of their hard-earned money. The court opened up charges against the nine defendants after sufficient evidence was tabled (Ellison, 2018). The medics received kickbacks in order to book in patients for spinal surgery at Pacific medical institutions. Out of the nine specialists indicted, three were orthopedic medical practitioners. One medic, Daniel pleaded guilty to receiving kickbacks and other additional conspiracy charges. Later on, the same doctor accounted for 142million insurer claims at Pacific medical institutions. Other physicians also received kickbacks for referring patients to Pacific Hospital. Pacific hospital management team were charged with overseeing illegal kickbacks and tax evasion.

Analysis of the Health Care Regulations Violated

 In this particular case, the primary illegality which led to arrest and investigation of the offenders is kickback. The False Claims Act applies to physicians- The Anti-kickback statute states that criminal regulations prevent the conscious and deliberate reimbursement of 'remuneration' to persuade or reward patient transfers or the fabrication of commercial on any article or serviceable payment by the federal medical care programs such as drugs, supplies, etc. (Office of inspector general USA department of health and human services, 2020). Remuneration comprises of anything valuable and can assume various forms such as rent and accommodation. Concerning this case and context, the nine surgeons openly received brides so that they can refer patients to Pacific Hospital. The anti-kickback statute does not permit these actions and the medics directly broke the law. Provisions of these laws protect people from social crimes and secure Medicaid finances. In the absence of this specific law, insurance policies would collapse due to the loss of money to fraudulent activities. Despite the additional clauses, this regulation inhibits medical practitioners from engaging in crime and neglecting their duties. Working in conjunction with other regulations such as the Stark law, this law is watertight as it ensures that medical procedures are handled ethically and lawfully. Through the Stark Law, the duties of medics are specialized and isolated hence making it easy to hold people accountable based on their actions. Consequently, this levels the playing field for all medical institutions. On the other hand, the anti-kickback statute forms the basis for professionalism and ethical conduct. Kickbacks abuse the prestige and transparency entrusted on medics. It corrupts and destroys the moral ground upon which humans survive and trust others with their lives. For instance, if a medical practitioner receives a bride, then it systematically impedes loyalty and tramples on the justice system put in place to protect and guide the medical practice (Ellison, 2018). Kickbacks take the dignity away from the medical sector and worsen quality delivery which in turn makes medical framework seem unfair to the patients and even subordinate workers. Most of the time, kickbacks affects poor people and prevents them from getting immediate medication. Therefore this law ensures the equal disbursement of medical resources and holds medical institutions responsible for failure to deliver quality medical services. The ability of anti-kickback statute to integrate and accommodate other medical regulations has led to the providence of supportable medical mechanisms meant for retaining medical development about the legal obligation of the people involved in safeguarding the legal structures of the medical facilities. Also, providing supplementary regulations to this particular regulation establishes the system underlying federal public medical department and building services based on management and accountability.

Implications of Anti-Kickback Statute On The Health Care System

 The health care system's role in preserving human life through the delivery of quality medical services. Anti-kickback statute directly or indirectly helps to stop corrupt under dealings from interfering with fair medical processes. A kickback is unfair and may create an inroad for incompetence to take route within the medical systems. In other words, the anti-kickback statute maintains the credibility of professional health workers and ensures everything is of high quality within the confines of the hospital. Corruption corrupts everything and keeping it at bay may be the best way of earning the trust of all the patients. Moreover, this law gives draws the parameters which in turn influence the medics' practice. For instance, a doctor cannot receive brides from a patient and vice versa is also applicable hence creating a fair environment for conducting medical dealings. In terms of protecting funds, this regulation ensures that all the people are well aware of payments made, either from the client to the medical specialist or from the medic to the management. At the end of it all, the anti-kickback statute ensures that all medical procedures are legal and are done under the correct medical procedures.

Recommendations of How the Hospital Can Prevent Another Kickback Violation

 The first thing they should do is to ensure that they sack the previous workforce who were found guilty of receiving bribes from patients. This way, the hospital management can have a fresh start free from any negative influence. Secondly, the inclusion of a third party who can oversee the payment process and secure a chance for each patient based on a first come first serve basis. A third party will hinder any outside influence and in the process protect the entire hospital from any suspicion incase the parties involved in bribery makes use of other mechanisms.  Internally, the medical hospital must call in a meeting and incorporate the use of information systems in communication and the entire payment process. Information systems automated communication and map out the entire management hierarchy which in turn makes it possible for one can detect any illegality be it kickbacks or delayed payment hence streamlining the payment process and removing any barriers (Nelson et al., 2019). In terms of stipulating regulations which will in turn influence how both the patients and medical experts conduct themselves is key in reducing kickbacks.  Hospital regulations set the pace for actions, mechanisms, opening and closing hours, discharge, and other matters that might require transparency. In time, the medical institution can come up with an additional department that will hold people accountable or report any illegal happening under their watch. As a matter of immediate intervention, the hospital can always look for outside assistance so that they can separate payment dockets from managerial sectors as an attempt to try and disburse the authority from top managers. All in all, the measure and interventions are supposed to close any weak loopholes found within the hospital payment system.

Supporting the Thesis Statement

 The statement the thesis statement states that an anti-kickback statute protects medical operations both indirectly and directly.

Explain

 The medical systems of any hospital depend on both the legal and ethical aspects of the individuals given the mandate to dispense their services. This eliminates the unfairness and introduces a leveled plating field within the medical sector as everyone gets an equal chance at accessing quality medical health care. Additionally, medics remain accountable for their actions and can be charged in a law of court for incase they break the law (Nelson et al., 2019). A profession that is given the chance to sustain and preserve life ought to be held at a higher standard than other professions hence penalizing them for taking part in bribery is still within the confines of the laws.

Support

 Everyone has a right to fight for their lives. An anti-kickback statute sets the framework for the legal framework to be realized and applied during any medical operation. Transparency is the back of the medical profession and anyone who goes against ethical norms and principles governing his or her medical profession should be held accountable through the legal laws (Nelson et al., 2019). This way, every part of the medical institution is protected from inferior supplies or even inadequacy. Subsequently, medical operations are carried out under a truthful vicinity which anyone can assess its truthfulness.

Conclusion

 The end of the medical profession is supposed to be free from any controversy while delivering its mandate to the public. Medical practitioners are to effectively and transparently conduct their profession based on fairness and legal frameworks such as the anti-kickback statute. All players in the medical field need a fair chance to cater to patients. Kickbacks might affect the quality of the medication received at the hospital hence reducing the level of trust people place on the doctors.

 

 

 

 

Reference

Ellison. A (2018) Ex-CFO, 3 surgeons charged in $950M kickback scheme in California Becker’s hospital review https://www.beckershospitalreview.com/legal-regulatory-issues/ex-cfo-3-surgeons-charged-in-950m-kickback-scheme-in-california.html

Nelson, J. A., Steward, S., & Vandigo, J. (2019). Pns129 Private Payer Perspectives On The Benefits Of Federal Anti-Kickback Statute Modernization To Promote Value-Based Arrangements For Medicines. Value In Health, 22, S307.

 Office of inspector general USA department of health and human services (2020). Anti-Kickback Statute [42 U.S.C. § 1320a-7b (b)] https://oig.hhs.gov/compliance/physician-education/01laws.asp