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EMTALA, Emergency Medical Treatment, and Active Labor Act is a regulation that requires health care establishments to provide emergency treatment and examination, regardless of individuals’ ability to pay, access to insurance, and legal status. The provisions focus on such services as medical screening requirements, stabilizing treatment, restriction transfers, and enforcement. Medical screening is offered to individuals who address the emergency department and request examination for a medical condition.
Hospitals are obliged to provide the corresponding service within the capacity of the department, including auxiliary services. Stabilizing treatment gives the individual the right to address the corresponding department for help whereas the task of the hospital is to deliver possible services and facilities for medical treatment or transfer the patient to another medical department, if necessary.
Although the Act solves the problem of uninsured people, there is significant controversy regarding the definition of an emergency condition, which will permit an individual to receive appropriate treatment. The matter of hospital responsibility for the individual they should treat is also considered, which implies that they must offer all terms and conditions that are within their capabilities. However, when their facilities and services are insufficient for meeting the clients’ concerns, they must inform another department that can accept the patient.
According to the Stark Law, there are several restrictions imposed on physician referrals, which means that a physician’s request for service is prohibited for Medicare patients from the designated health services. Such a prohibition is followed by penalties, including refunds of money received by doctors for services up to $ 15,000. The prohibition imposed on self-referral by physicians for clinical services under the auspices of the Medicare program is stipulated by Stark I Law. The second part of the law covers a series of issues on the behavior of provider groups. Specifically, the second provision focuses on eliminating the conflicts caused by physicians’ decision-making.
However, there is concern about the case of unwarranted intrusion into health care practices. The critics have stated that the regulations, particularly those referring to compensation issues, are too sophisticated and may prevent physicians from taking part in managed care processes. Under the provisions of the Stark Statute, the restriction to referral patterns and business relationships is reasonable because it will contribute to objectivity and equality in treating patients.
The False Claims Act is federal legislation that imposes responsibility on physical and legal entities that withdraw money from governmental programs by fraud. The provision includes a “qui tam” section, according to which individuals are allowed file actions on the part of the government in case they are not connected to administrative organs. Individuals filing under the law can receive compensation for possible damages. It also can be put in effect in such spheres as health care, governmental affairs, and the military.
Despite the initial good intentions of the Act, it can posit a significant threat to medical practice. Specifically, the law prohibits many misconduct cases, including improper retention of money overpaid to federal funds, or introducing false statements to the governmental authorities. Even though the Act implies certain responsibilities that individuals must take, the act is enforced only after an individual deliberately ignores the described circumstances. The pitfall, therefore, does not allow the government to ensure successful allocation of financial resources, as well as define which measures could be taken to prevent false claims submission.
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