When you run a medical practice, you are subject to a lot of government oversight, especially when handling federal health care patients. One law that physicians and medical practices must abide by is the Stark Law, a federal statute first passed in 1989 and revised three times since then. Each revision has added more provisions and exceptions to the law, making it sometimes difficult to comply with.
Regulating physician referrals
The Stark Law regulates physician’s referrals. Physicians cannot refer Medicare and Medicaid patients for additional tests or services if they (or a relative) have a financial interest in the company administering the tests. One exception is that physicians in group practices can refer patients to someone within their own practice.
Some of the health care areas the Stark Law covers includes the following:
- Clinical lab services
- Physical therapy
- Occupational therapy
- Radiation and supplies
- Medical equipment and supplies
- Inpatient or outpatient hospital services
- Home health services
Violations come without intent
One of the most difficult parts of the Stark Law is that physicians can violate it without intent. If a physician makes a referral and it doesn’t meet the law’s exemptions, then that is a Stark Law violation. Violations can lead to fines up to three times the amount claimed from Medicare—up to $15,000. If a health care provider knowingly violated the Stark Law, Medicare and Medicaid can disqualify them from providing services as part of those programs.
The Anti-Kickback Statute also is a federal law that regulates physician referrals. It prohibits physicians from offering, soliciting, paying or receiving anything of value for referrals that lead to increasing any federal health care patients (not just Medicare and Medicaid patients). So, physicians can’t receive any items or services for referring federal health care patients to other health care services, nor give another health care provider anything for referring patients receiving federal health care.
With the Anti-Kickback Statue, a physician’s intent must be proven. They need to know about the kickbacks and have received or given them willfully.
Fines for violating the Anti-Kickback Statue can reach up to $50,000. Physicians violating the Anti-Kickback Statute also can face a five-year prison term.
If you feel you know of a Stark Law violation or a violation of the Anti-Kickback Statue, or you as a physician are facing a violation of either provision, seek legal help. An attorney with experience in medical fraud cases can help determine your best plan of action.