What is the purpose of the Stark Law?
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
What are the Stark Law exceptions?
For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R.
When did the Anti-Kickback Statute start?
1972
Enactment and Expansion of the Federal Anti-Kickback Statute In an effort to ensure that only necessary items and services were being provided to Medicare and Medicaid beneficiaries, Congress passed the AKS in 1972, as an amendment to the Social Security Act.
What is Stark I and Stark II?
Stark I deals with clinical laboratory services, and Stark II, which came out in 1995, extended the reach of the prohibition to 11 categories of designated health care services.
What is Stark II?
Stark II prohibits a physician or immediate family member who has a direct or indirect financial relationship with an entity from making referrals to that entity to provide designated health services (DHS) payable by Medicare or Medicaid, unless an exception applies.
Who created Anti-Kickback Statute?
In 1972, Congress passed the Anti-Kickback Statute to ensure Medicare and Medicaid patients received sound medical advice and that referrals of patients to other health care providers were based on the best interests of the patients and not the potential benefit to the referrer.
Who created Stark Law?
Representative Pete Stark
Interestingly, the main author of the initial legislation, former Representative Pete Stark, noted in 2013 that he would actually be in favor of repealing the law.
Which is an example of a Stark law violation?
An example of a Stark law violation is a hospital paying doctors money to refer cardiac patients to their hospital. Similarly, it is a violation of Stark for a laboratory or outpatient clinic to pay hospitals to refer patients to them.
How can we prevent Stark laws?
To comply with the Anti-Kickback Statute and Stark law, provider compensation for clinical and administrative activities must be consistent with Fair Market Value and not take into consideration the value or volume of referrals the provider brings to the health care organization.
What are the elements of the Stark Law?
The Stark Law prohibits (1) a physician from making referrals for certain designated health services (“DHS”) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship, unless an exception applies, and (2) the entity receiving the referral from submitting claims …
What started the Stark Law?
The Stark Law was enacted by Congress in 1989 as the Ethics in Patient Referrals Act. The initial intent was to prohibit physicians from referring Medicare patients to clinical labs in which the physician had some financial relationship, including an ownership interest.