STARK LAW and Anti-Kickback Statute
We are a health law firm with offices in Augusta and Atlanta, Georgia, and our focus is representing healthcare providers. We advise and represent medical practices, 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.
National Health Law Attorneys
Our health law firm endeavors to advance and protect the financial interests of healthcare providers by helping them avoid regulatory pitfalls that involve serious adverse financial consequences. Our services include:
- Physician Self Referral Act (a.k.a. STARK Law): We help medical practices and physicians 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 medical practices, physicians and 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 customers avoid inadvertent violations of regulatory compliance requirements that might trigger substantial financial penalties under CMP.
The focus of our health law firm is helping medical professionals and healthcare businesses succeed. We represent healthcare providers throughout the United States. To schedule a consultation with one of our experienced health law attorneys, contact us today.
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 it makes sense to reward those who send you business with financial incentives. But if you are in a healthcare business, improper referral relationships can have dire financial consequences.
For example, 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:
- Clinical laboratory services;
- Physical therapy services;
- Occupational therapy services;
- Radiology services (including MRI and ultrasound);
- Radiation therapy services and supplies;
- Durable medical equipment and supplies;
- Parenteral and enteral nutrients, equipment and supplies;
- Prosthetics, orthotics, and prosthetic devices and supplies;
- Home health services;
- Outpatient prescription drugs;
- Inpatient and outpatient hospital services;
- Outpatient speech-language and pathology services;
If Stark law 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 law 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 law. Doctors who violate Stark alaw may also be excluded from the Medicare and Medicaid programs.
Compliance with Stark law
If you are unsure about a particular arrangement’s compliance with Stark law, 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 statutory exceptions applies, the arrangement is likely prohibited.
If you have questions concerning Stark law or Anti-kickback rules, or other regulatory issues, and would like to schedule a confidential consultation, please, contact us today.