The Stark Amendment to Omnibus Budget Reconciliation Act of 1989 — and its various amendments and administrative rules/regulations — is the federal government’s system to prevent physicians from referring patients to entities in which they have a financial interest. The Stark Amendment had a three-phase implementation: Stark I, II and III.
Stark I originally only applied to physicians and their family members and prohibited self-referrals to clinical laboratories in which the physician had a financial interest.
Stark II amended the act in 1993, greatly expanding covered entities beyond physicians and clinical laboratories.
Stark Laws are one of several forms of healthcare fraud prevention. Generally, a physician is prohibited from making any referral to a person or entity in which the physician has a financial interest. This is generally referred to as physician self-referral, which is what Stark Laws are aimed to prevent.
The proponents of Stark argue such arrangements may encourage over-utilization of services, in turn driving up health care costs. In addition, they believe it would create a captive referral system, which limits competition by other providers.
Those in favor of relaxing Stark requirements argue that physicians who own, invest in or operate medical facilities are responding to a need for medical services that would otherwise not be met, particularly in medically underserved areas.
In addition, it is often the case that physician-owned entities present a lower-cost alternative to the facilities which are located at hospitals. This is due mostly to higher overhead costs that hospitals must pass down to their services.
The Center for Medicare and Medicaid Services (CMS) is responsible for implementing the vast array of Stark regulations and statutes. In response, they continue to extend Stark’s reach by implementing regulations which greatly expand the definition of “financial interest.”
Currently, a financial interest involves just about anything that results in a financial benefit to the referring physician. This could include ownership, investment, gifts, freebies, financial incentives, reduced rent, reduced fees, structured compensation arrangements and unfair compensation schemes.
Yes, certain exceptions can apply to Stark Laws. For example, if the physician personally provides the services or is an employee of a medical group that provides the service, there may be no liability. This allows for multidisciplinary practices as long as the physician meets the definition of “physician in the group practice.”
There are also exceptions for in-office ancillary services. However, if the arrangement is not structured as a block lease, it may not qualify for the space and equipment lease exception. Additionally, there are Safe Harbor Regulations that make exceptions for investments in large publicly traded entities, rural physician practices, etc.
There are also a host of other exceptions to allow for rental of office space, employment and service arrangements with hospitals and certain other service arrangements. These arrangements must be at arms length and at fair market value.
The determination of whether or not your particular situations falls into one of these exceptions is a very complicated analysis and requires complete operational and financial disclosure. The risks of making an incorrect determination can be devastating.
Penalties include:
The Stark Law lawyers at Chapman Law Group are experts in making sure your practice is not running afoul of the rules and regulations — and not susceptible to federal criminal charges.
For 35 years, we have provided compliance program consultation and development for clients all across the U.S. — from Chicago to Houston, and from San Francisco to Philadelphia.
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The government made things easier for healthcare providers who want to end fee-for-service and go the value-based or coordinated care route.
In general, a physician or other licensed healthcare provider is prohibited from making any referral to a person or entity that bills Medicare or Medicaid programs, and with which the physician has a financial interest. And there are hefty penalties for doing so.
These waivers and exceptions from sanctions are meant to allay health care providers — as they could find themselves, while treating patients during COVID-19, in situations that would otherwise constitute health care fraud.
If you are a Michigan-licensed doctor, nurse, physician’s assistant, certified nurse assistant, physical therapist, chiropractor, therapist, psychologist or psychiatrist, new changes to the Public Health
New healthcare business ventures can easily, sometimes unknowingly run afoul of Stark Law, Anti-Kickback, and the False Claims Act. Here’s how to be sure you are being fully compliant and not violating any state and federal laws.
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