The Stark Law contains several exceptions, including physician services, in-office ancillary services, ownership in publicly traded securities and mutual funds, rental of office space and equipment, and bona fide employment relationship. 0000003067 00000 n 0000089275 00000 n According to the Centers for Medicare & Medicaid Services (CMS), the following services are covered by the Stark Law under the DHS category: The U.S. Department of Health and Human Services Office of Inspector General (OIG) includes the Stark Law as one of the five most important federal fraud and abuse laws applying to physicians. In recent years, the laws of the United States have undergone a whistleblower revolution. Please seek medical advice before starting, changing or terminating any medical treatment. The goal of the Stark Law was to prevent physicians from self-referring patients for their own financial gain. Physician Self-Referral Law (Stark Law) Basics The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients The American Society of Anesthesiologists (ASA) explains that these are some of the consequences of Stark Law violations: There are certain exceptions to the Stark Law. Call (713) 909-7323 or contact us online to discuss your lab's compensation structures and referral arrangements. WebThe Stark Law is a complex regulatory framework that focuses on physician financial relationships with entities in which a physician could refer certain services. The fee-for-service healthcare delivery system encouraged physicians to focus on the number of procedures, patients, and claims filed versus how well the patients health goals were being met by these services. Stark Law is one of the best legal remedies in eliminating the social virus in the healthcare system. Removing as much financial influence from these areas as possible is a valuable and crucial goal. 122 34 122 0 obj <> endobj 1395nn). DHS includes 10 categories of services, including inpatient and outpatient hospital services, clinical laboratory services, and radiology and other imaging services. Hence, improper payments may result in the billing of unnecessary medical services and treatment. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); What does Stark Law specifically prohibit? Stark Law only applies to Medicare participants who receive a referral for a designated health service. Why Medical Billers and Coders (MBC) is Preferred ASC Billing Company? The events largely took place at fancy restaurants, and in some cases never at all - payments were simply offered to physicians, and withheld from others who failed to increase their prescription rate of Novartis products. In-Office Ancillary Service is one of the Stark Law Exceptions that allows physicians and other medical practitioners for certain DHS referrals within practice. The aim is to focus on patient outcomes and cost savings. WebIn many respects, the Stark Law exception for renting equipment is similar to the exception for office space. Continue to update documentation as healthcare relationships grow or change. You can unsubscribe at any time. If you have any questions contact us anytime! 0000000994 00000 n Under the Stark Law, physicians cannot refer or recommend that patients receive certain health services from providers with whom they or family members of theirs have a financial relationship. The Stark Law is defined as a set Strict liability is a form of legal liability in which the individual who violated the law is held responsible, even if they had no intention of doing so and the court can find no fault or specific action that the practitioner did that resulted in the violation. 1395nn). 0000001219 00000 n 2) The law also prohibits the billing of Medicare or other insurance providers for health services when an improper physician referral was made. [2] In specific, what is referred to as "Stark I" prohibited a physician referring a Medicare patient to a clinical laboratory if the physician or his/her family member has a financial interest in that laboratory. Within the law itself is a series of best practices for creating effective and Stark-compliant HCP contracts, known as safe harbor provisions. Stark Law is a federal law that prohibits physicians from referring patients for certain health care services to any entity with which the physician or immediate family has a financial relationship. In recent years, enforcement of Stark Law has become increasingly aggressive, largely as a result of the Patient Protection and Affordable Care Act and its amendments to the False Claims Act. endstream endobj 123 0 obj <>/Metadata 4 0 R/Pages 3 0 R/StructTreeRoot 6 0 R/Type/Catalog/Lang(en-US)>> endobj 124 0 obj <>/MediaBox[0 0 612 792]/Resources<>/Font<>/ProcSet[/PDF/Text/ImageC]>>/Type/Page>> endobj 125 0 obj <> endobj 126 0 obj <> endobj 127 0 obj <>stream In 1993 and 1994, Congress expanded the prohibition to additional DHS and applied certain aspects of the physician self-referral law to the Medicaid program. In this article, well cover the basic elements of the Stark Law, notable cases, and tips to avoid violations. A safe harbor provision is a law or series of compliance steps that, if followed, will limit or eliminate liability if a violation is reported. To expound, the law defines referral as the act of a physician referring to his own medical practice or to include services performed by a referring physicians coworkers, employees, or independent contractors. Attorney Advertising Notice: Prior results do not guarantee a similar outcome. If the doctor in question refers the patient to their spouse's company - even if doing so is not motivated by financial gain - they are in violation of the Stark Law. GoodRx provides no warranty for any information. Penalties for violating this law are severe, even when the practitioner did so unknowingly or unintentionally. 1395nn of the U.S. Code. The law only applies to Medicare patients seeking designated health services. The Stark Law also prohibits the DHS Entity from billing Medicare or any other person or entity for improperly referred DHS (the Stark Laws billing prohibition). Reducing administrative burdens that increase costs so the money can be spent on patient care. NLR does not answer legal questions nor will we refer you to an attorney or other professional if you request such information from us. Contact our Account Receivables Specialist today! The Stark law may impede certain pay for performance value-based arrangements, which led to discussions around reform as of 2019.[6]. Save my name, email, and website in this browser for the next time I comment. So in order to combat this, federal laws such as the Physician Self Referral Law or Stark Law seek to prevent these abusive and fraudulent activities in our healthcare system. The Physician Self Referral Law, more commonly known as the Stark Law, protects Medicare and Medicaid patients from receiving referrals based on financial interests. Explore the consequences of violations and the Stark Law exceptions. These include arrangements where the physician receives essential, non-monetary remuneration exclusively used to send and receive electronic prescription information. 0000001396 00000 n When the Stark Law was enacted in The Stark Law was enacted in 1989 to prevent doctors and medical practices from receiving income from making referrals under many circumstances. For more information, speak to a qualified qui tam lawyer to understand what kinds of proof are necessary and allowable by law. ?F"@-\~_?G/4I\ It seeks to ban the abusive practices of physicians and other health care service providers. 0000003343 00000 n Stark law essentially provides that referrals between a physician and a designated health practice (DHS). We shared summarised but crucial information about Physician Self-Referral Law (Stark Law) for your reference. The Office of the Inspector General (OIG) is tasked to investigate suspected healthcare fraud activities and report cases to the U.S. Department of Justice (DOJ) for criminal or civil actions. More examples are the Bona Fide Employment Exception, In-Office Ancillary Services Exception, and Whole Hospital Exception. Stark Law essentially prohibits a physician from making referrals to a patient for a particular designed healthcare service that is payable by Medicare or Medicaid to an entity. Essentially, the more risk the physician is taking, the less medical scrutiny. Healthcare Facilities oOZ$fmS{b4E}s^q) l"f)_H=q2SgW~?u|*r1@uMecKaiH"M-,Oy0Q#D}KrYOP}#wlov[/. WebIn Anti-Kickback Statute and Stark Law cases that are the basis of a False Claims Act case, the False Claims Act penalties are just the first half of the penalty phase. Any legal analysis, legislative updates or other content and links should not be construed as legal or professional advice or a substitute for such advice. The DOJ, through the guidance of the Federal Bureau of Investigation, investigates suspected Stark Law violations and evaluates if such cases are in conjunction with violations of the Anti-Kickback Statute or the False Claim Acts. endstream endobj 154 0 obj <>/Size 122/Type/XRef>>stream 0000089922 00000 n Originally, Stark I intended to abolish any physicians financial scheme in sending patients for unnecessary testings. Even non-intentional connections involving financial ties may be in violation of the Stark Law. If you have information about possible kickbacks or violations of the Stark Law, speak up. In case any assistance is needed for Medicare billing or submitting claims to private insurance carriers, contact us at info@medicalbillersandcoders.com/ 888-357-3226. For example, as discussed above, the definitions of a group practice and fair market value have changed. Critics argue that this practice is an inherent conflict of interest, because the physician benefits from the physician's own referral. endstream endobj 128 0 obj <> endobj 129 0 obj <> endobj 130 0 obj <>stream WebPennsylvania law requires a party seeking to enforce a restrictive covenant to show that its enforcement is reasonably related to the protection of a legitimate business interest. You can even refer to the CMS document on, Physician Self-Referral Law: Frequently Asked Questions, is a leading medical billing company providing complete revenue cycle services. Healthcare experts agree that information technology is necessary to streamline hospital processes, including those relating to compliance and Stark Law. Public whistleblowers check safety practices inside the healthcare organization, report healthcare fraudulent activities committed outside the organization, and encourage other whistleblowers to speak up. 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