Stark Exceptions Explained
Stark Law Exceptions
Physicians and other health care providers should learn about healthcare fraud and abuse as defined under the Stark law. These laws are supposed to stop physicians from referring patients for certain health services that are paid for by Medicare and Medicaid to any entities which the physicians or their relatives have a “financial relationship”. A “financial relationship” could mean that the physician has invested or owns the entity, or has a compensation agreement with that entity.
Penalties For Violating The Stark Law
Physicians can face severe penalties if they knowingly or unknowingly violate the Stark Law. Some of the penalties they face include:
- A $15,000 fine per billed service from the illegal referral
- Triple the amount of damages the government incurred because of the violation
- Attorney’s fees
- For intentional violation they can face provider exclusion and other penalties
The penalties of stark violations are indeed severe and that is why healthcare professionals must ensure that any designated health service referral is done in compliance with regulations. Talk to a lawyer to help you review contracts and billing practices to ensure that you do not violate the Stark Law.
Differences The Between Stark Law And The Anti-Kickback Statute
The Stark Law and the Anti-Kickback Statute are both federal laws that deal with remunerations related to illegal referrals. But the Stark Law is exclusively a civil enforcement statute while the Anti-Kickback Statute includes both civil and criminal penalties. The Anti-Kickback statute is not just limited to designated health services (DHS) paid for by Medicaid and Medicare, it also applies to any other federal healthcare program. Another difference is that you face penalties whether or not you violated the Stark Law intentionally. On the other hand, intent has to be proven when charging someone for violation of the Anti-Kickback Statute. Finally, there has to be a referral relationship between a physician and an entity under Stark Law, but the Anti-Kickbacks Statute applies to any referral source.
Conditions For Exceptions To The Stark Law Prohibitions
Exceptions to the Stark Law are meant to make it easier for a patient to access the entire quality healthcare they need. Each exception has a number of conditions that must be met for the physician or medical professional to avoid liability. Some of the conditions for stark law exceptions include:
- Referral relationships must meet all the requirements of an exception as defined by the law
- Referring physicians and their providers must have written agreements for things such as office space or equipment leases, fair market compensation and more
- Compensation should not be based on the volume or value of a physician’s referrals
- A medical practice can only qualify for stark exceptions if the practice meets all elements of the statutory definition of group practice such as requirements governing the structure of a group
Some examples of stark exceptions include:
- A group medical practice can make referrals for in-office ancillary services such as radiology or laboratory services
- Allows fair market compensation if there is a written compensation agreement that specifies a timeframe and the compensation that will be given
- Indirect compensation between physicians and entities is allowed if the compensation the physician receives, is of fair market value and is not determined by the volume or value of referrals