Stark Law – Doctors Prohibited from Patient Referral
The Stark Law is a healthcare law related to healthcare fraud and abuse law. It prohibits physicians from referring patients in certain instances. For example, the doctor can not refer a patient for a health service paid for by Medicare to any other medical facility where the doctor has a financial relationship. What defines a financial relationship? It would include any direct or indirect ownership or investment by the referring doctor in that other medical business. This would also include any financial interest in the second medical business if that business if owned or partially owned by the doctor’s immediate family members. The Stark Law is not a criminal statute, but the Anti-Kickback Statute is a criminal statute with criminal penalties. The Stark Law statute applies to physicians who refer Medicare and Medicaid patients for specific services. These services are called designated health services (DHS) to healthcare businesses. Various types of designated health services may include but not be limited to the following: clinical laboratory services, occupational therapy, physical therapy, radiology services, MRI services, CT scans, ultrasound work, and radiation therapy. DHS may also include providing medical equipment, prosthetics, orthotics, home health services, outpatient prescription drugs, and other outpatient services.
Stark Law is also known as the self-referral law. A doctor that refers a Medicare or Medicaid patient to an entity in which the provider or an immediate family member has a financial interest, should consider self-referral. A doctor that determines that he violated provisions of the Stark Law should hire a healthcare lawyer to communicate with the Office of the Attorney General (OAG). It may be possible to negotiate a financial settlement. Such a settlement may be significantly less than the total amount that the OIC claims is required to make full restitution. Call an experienced healthcare lawyer if you need to prevent a situation where the OAG investigates you. Call a Medicare overpayment lawyer if the OAG learns that you knew about the financial relationship with the other service provider after an investigation. In such a situation, under the current legal environment, the OAG may compel you to pay full restitution, plus penalties and interest.
Violation of the law may lead to severe penalties. Please consult with a healthcare law attorney in order to determine if the Stark law applies to you. Do you refer of Medicare or Medicaid patients? Does your business relationship with the third party involve a “designated health service”? Contact a Texas healthcare lawyer to examine your financial relationship with the receiving entity accepting the referral. Do you qualify for some of the exceptions? An exception may include a situation where the financial relationship includes, rental or officer space, rental of equipment, and genuine employment relationships,
Medicare Overpayment Situations Causing Harm to a Physician practices
One of the more recent and more popular causes for harm to a business include negative business reviews. Our law firm assists businesses in an effort to help resolve problems related Medicare and Medicaid overpayments.
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