In order to combat healthcare fraud and abuse, the Stark Law outlines what healthcare providers can and cannot do when it comes to referrals for particular health services paid for by Medicare and Medicaid. Violations of the Stark Law carry severe penalties, even if a physician does so unknowingly.
However, the Stark Law allows for patients to access high-quality healthcare if necessary through a few clearly defined exceptions.
Stark Law exceptions
The prohibitions outlined in the Stark Law do not permit healthcare providers to refer their patients for certain health services, particularly those funded by federal healthcare programs if it will result in financial gain. The law does include some exceptions, which include:
- Referrals within some specialty facilities
- Group medical practices referring for in-office ancillary services
- Physician referrals between members of a group practice
- Bonafide employees of academic medical centers
- Implants and devices furnished by Ambulatory Surgery Centers
- Referrals for necessary preventive services
In each of these and other exceptional circumstances, providers must meet a strict set of conditions in order to qualify as an exemption.
Detailed requirements and conditions
Though the Stark Law includes exceptions, medical providers must comply with the rigid compliance standards outlined in the mandate. Providers must completely disclose all financial and operational data in order to qualify for an exception. As well, because the Stark Law overlaps with the Anti-Kickback Statute, medical provider intent becomes relevant.
Medical providers should review all contracts and billing practices before making referrals to ensure compliance with the Stark Law and the Anti-Kickback Statute, and any potential exceptions should receive professional legal examination before conclusion.