There are many federal and state laws that physicians are required to abide by, including laws that address fraud and abuse. According to the Office of Inspector General, U.S. Department of Health and Human Services (OIG), the most serious of these laws include the Physician Self-Referral Law (Stark Law), the Anti-Kickback Statute (AKS), and the False Claims Act (FCA). Violations of these laws can result in severer penalties, including exclusion from federal health care programs, civil fines, loss of medical license, and even criminal penalties. In our next few posts, we will discuss each of these laws and how they may affect your practice. In this post, we will look at the Stark Law.
The Physician Self-Referral Law
The Physician Self-Referral Law, referred to as the Stark Law, bans doctors from referring patients to other medical providers for services that will be paid by Medicare, Medicaid, or other programs if the referring doctor or a member of their immediate family has any type of financial relationship with the medical provider they are referring. Basically, a doctor cannot refer a patient in exchange for receipt from that provider of anything of value. They also cannot present claims to Medicare or other healthcare program for referred services.
The Stark Law is meant to protect patients from procedures – and medical expenses – that are unnecessary. It also applies to all medical facilities, whether a small private practice or a large health care system. There are some exceptions to the Stark law, however, those exceptions are very limited.
...