Los Angeles, CA asked in Products Liability, Health Care Law, Medical Malpractice and Personal Injury for California

Q: Which Medicare regulations impose legal liabilities?

Which Medicare regulations impose legal liabilities on Hospital and doctors, other then FCA and Stark law?

2 Lawyer Answers
James L. Arrasmith
James L. Arrasmith pro label Lawyers, want to be a Justia Connect Pro too? Learn more ›
  • Estate Planning Lawyer
  • Sacramento, CA
  • Licensed in California

A: Under Medicare regulations, several laws impose legal liabilities on hospitals and doctors in California, besides the False Claims Act (FCA) and Stark Law.

The Anti-Kickback Statute (AKS) is crucial. It prohibits offering, paying, soliciting, or receiving anything of value to induce or reward referrals or generate Federal health care program business. Violations can result in criminal and civil penalties.

The Health Insurance Portability and Accountability Act (HIPAA) also plays a significant role. It sets standards for protecting sensitive patient health information. Non-compliance can lead to substantial fines and legal consequences.

The Emergency Medical Treatment and Labor Act (EMTALA) mandates hospitals to provide emergency medical treatment regardless of the patient's insurance status or ability to pay. Failure to comply can result in penalties, including fines and exclusion from the Medicare program.

Lastly, Medicare Conditions of Participation (CoP) set forth minimum health and safety standards that hospitals must meet. Non-compliance can lead to various sanctions, including termination of Medicare provider agreements.

Understanding these regulations is vital to avoid legal liabilities and ensure compliance with Medicare requirements. It's recommended to stay informed and seek guidance when needed to navigate these complex legal obligations.

Tim Akpinar
Tim Akpinar
  • Medical Malpractice Lawyer
  • Little Neck, NY

A: Guidelines for timely submittal of claims is a fundamental one, as well as privacy-related issues (covered under HIPAA, although this applies to other types of medical claims as well). Good luck

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