STARK LAW and Anti-Kickback Statute

We are a business and healthcare law firm with offices in Augusta and Atlanta, Georgia, and our focus is representing healthcare providers. We advise and represent Georgia and South Carolina physicians and healthcare businesses with regard to STARK, the Anti-Kickback statute, and other federal and state laws and implementing regulations. Federal and state regulatory laws place more restraints upon physicians than any other licensed professionals. These laws impact not only physicians, but any healthcare business with which they transact business.

Atlanta Healthcare Attorneys

Our Atlanta healthcare law firm advances and protects the financial interests of healthcare providers by helping them avoid regulatory pitfalls that involve serious adverse financial consequences. Our services include:

Stark Law
  • Physician Self Referral Act (a.k.a. STARK Law): We help Georgia and South Carolina physicians (or their prospective employers or business partners), ensure their transactions and arrangements are structured in a legally compliant manner to avoid improper referrals of designated health services between entities with a prohibited financial relationship.
  • Anti-Kickback Statute (AKS): We protect Georgia and South Carolina healthcare businesses by evaluating and structuring financial arrangements between entities to ensure compliance with the AKS and avoid costly penalties and other adverse business consequences.
  • Civil Monetary Penalties (CMP) Law: We help our healthcare clients avoid inadvertent violations of regulatory compliance requirements that might trigger substantial financial penalties under CMP.

The focus of our healthcare law firm is helping medical professionals and healthcare businesses succeed. We advise and represent doctors and doctor groups or associations, ambulance services, FQHCs, geriatric care businesses, healthcare professionals, healthcare consultants, laboratories, and other healthcare related businesses. We represent healthcare providers in Atlanta and Augusta, Georgia; Aiken, South Carolina; and throughout the Communities We Serve. To schedule a consultation with one of our attorneys, email us at info@hamillittle.com or contact us at our office nearest you.

If you are a healthcare provider, throw away normal business instincts when it comes to referral relationships

For just about any business other than one in healthcare, of course it makes sense to reward those who send you business with financial incentives. Doing so makes good sense, right? But if you are in healthcare, improper referral relationships can have dire financial consequences.

The STARK law makes it illegal for doctors to refer patients for any of 12 designated health services (“DHS”) to an entity with which the doctor (or an immediate family member of the doctor) has a financial relationship, absent an applicable exception. The list of DHS follows:

  1. Clinical laboratory services;
  2. Physical therapy services;
  3. Occupational therapy services;
  4. Radiology services (including MRI and ultrasound);
  5. Radiation therapy services and supplies;
  6. Durable medical equipment and supplies;
  7. Parenteral and enteral nutrients, equipment and supplies;
  8. Prosthetics, orthotics, and prosthetic devices and supplies;
  9. Home health services;
  10. Outpatient prescription drugs;
  11. Inpatient and outpatient hospital services;
  12. Outpatient speech language and pathology services;

If STARK prohibits a referral for DHS, the entity providing the DHS may not bill the patient, Medicare or Medicaid programs or any other entity for such services and the entity must refund any payments it collected for the DHS. Violations of this prohibition are costly. For each “non-compliant” bill submitted for services provided and/or each failure to make a required refund, a civil monetary penalty of $15,000 may be imposed. STARK also imposes a penalty of up to $100,000 for any circumvention schemes or arrangements that a doctor knows (or should know) has the principal purpose of assuring referrals by the doctor to the entity that, if the doctor directly made the referral, would violate STARK. Doctors who violate STARK may also be excluded from the Medicare and Medicaid programs.

Compliance with STARK

If you are unsure about a particular arrangement’s compliance with STARK, proper legal analysis includes evaluation of the following steps: (1) is the service provided to a patient covered by Medicare or Medicaid; (2) is the service provided to the patient a DHS; (3) is the service provided by an “entity”; (4) pursuant to a “referral”; (5) from a “physician”; (6) with whom the entity has a “financial relationship”? If the answers are “yes,” then, unless one of STARK’s exceptions applies, the arrangement is likely prohibited.

If you have questions concerning STARK and Anti-kickback rules, or other regulatory issues, and would like to schedule a consultation, email us at info@hamillittle.com or contact us at the office nearest you.