Question

What are the Stark and Anti Kickback Laws? Describe them and how they may effect healthcare policy

2) What laws that regulate the Health Insurance industry may effect healthcare policy?

Answer 1

1. The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of financial relationships.

Kickbacks are arrangements made between providers in which one party refers patients to another through services, goods or medicines. ... In this hypothetical, the physician is giving out medicine not to treat their patient's condition, but because they are receiving payments from the company that makes the drug.

2. Insurence regulatory lawIs the body of statutory law, administrative regulations and jurisprudence that governs and regulates the insurance industry and those engaged in the business of insurance. Insurance regulatory law is primarily enforced through regulations, rules and directives by state insurance departments as authorized and directed by statutory law enacted by the state legislatures.

Insurance is characterized as a business vested or affected with the public interest.^[2] Thus, the business of insurance, although primarily a matter of private contract, is nevertheless of such concern to the public as a whole that it is subject to governmental regulation to protect the public’s interests.^[1]

Therefore, the fundamental purpose of insurance regulatory law is to protect the public as insurance consumers and policyholders. Functionally, this involves:

• Licensing and regulating insurance companies and others involved in the insurance industry;
• Monitoring and preserving the financial solvency of insurance companies;
• Regulating and standardizing insurance policies and products;
• Controlling market conduct and preventing unfair trade practices; and
• Regulating other aspects of the insurance industry.^[3]