Physician Self-Referral or Stark Law
The Stark law generally prohibits physicians from referring patients for Designated Health Services to facilities in which the physician or an immediate family member has a financial interest.
A “referral” can include ordering or certifying the need for a designated health service.
A “financial interest” is defined broadly to include an ownership interest, investment interest, or compensation arrangement. It covers both direct relationships and indirect benefits, such as when a hospital provides a physician with below-market rent for office space.
The Designated Health Services (DHS) covered by the Stark statute include:
The Stark law also prohibits anyone from billing Medicare or Medicaid for services provided as a result of a self-referral. Any such claim for reimbursement is considered a “false claim” under the False Claims Act.
Several exceptions to the general rule exist, including physician services, in-office ancillary services, ownership in publicly traded securities and mutual funds, rental of office space and equipment, and bona fide employment relationships.
To arrange a free and confidential consultation, call John Howley, Esq. at (212) 601-2728.
Examples of Stark Law Violations
Part-Time and Consulting Contracts with Referring Physicians
A jury has found that Tuomey Healthcare System in Sumter, S.C., violated the Stark Law by paying doctors in ways that rewarded them financially for referring patients to the hospital. The jury found that more than 20,000 Medicare claims were tainted by the illegal compensation arrangements. Click here to read more....
Incentive Payments to Doctors
Freeman Health System agreed to pay $9.3 million to resolve allegations that it knowingly provided incentive pay to physicians who referred patients to the hospital system. The settlement resolves claims by the U.S. government that such incentive payments violated the False Claims Act and the Stark Law. Click here to read more....
Physician Office Leases
HCA Inc. agreed to pay $16.5 million to settle claims that it violated the False Claims Act and the Stark Statute by entering into favorable leases with physicians who referred patients to the hospital. The whistleblower who brought the case will receive 18.5% of the settlement as a reward, or more than $3 million. Click here to read more....
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