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.
When did the Stark Law become effective?
Readers may remember that just one day before President Joe Biden was inaugurated as the 46 th President of the United States, on January 19, 2021 , a final rule issued by the Centers for Medicare and Medicaid Services (CMS) modernizing the physician self-referral law (the Stark Law) became effective.
Who invented the Stark Law?
Pete Stark , a Democrat from California, who sponsored the initial bill. 2. The original statute was quite simple. It sought to ban physician self-referral for designated services when a patient was covered by Medicare or another government payer.
What is the purpose of 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.
Who regulates Stark Law?
The Affordable Care Act, however, requires the Secretary of HHS to ensure a process for providers to self-disclose Stark Law violations. 18 This statement is based on the author’s 24 years of practical experience.
What is the difference between the Stark Law and the Anti-Kickback Statute?
Source of Prohibited Referrals: Whereas the Stark Law is only concerned with referrals from physicians, the Anti-Kickback Statute applies to referrals from anyone . ... In addition to civil sanctions, the Anti-Kickback Statute also provides for criminal punishment.
Who does the Anti-Kickback Statute apply to?
The Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b), covers a broader range of activity than the Stark Law, and extends to all medical providers in a position to arrange or recommend medical services .
Does Stark apply to psychologists?
Myth 1: The Stark statute and the anti-kickback statute are the same. The Stark statute pertains exclusively to Medicare and Medicaid services and applies only to clinicians who are considered physicians . . .
What is Stark II law?
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.
Can a doctor refer to himself?
The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.
What are two exceptions allowable under Stark?
There are two exceptions in the Stark statute relevant to these relationships: the bona fide employment relationship exception and the personal services arrangements exception (described later).
What is a safe harbor under the Stark Act?
The AKS Care Coordination Arrangements safe harbor protects in-kind (nonmonetary) remuneration within compliant value-based arrangements that further patient care coordination purposes . This safe harbor requires no assumption of downside risk by parties to a value-based arrangement.
What is considered an illegal provider relationship?
Which of the following is considered to be an illegal provider relationship? Any person or entity who knows, or should have known, of the presentation of a false or fraudulent claim to the government for payment or approval is subject to .
What is an example of a Stark Law violation?
Entering into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey in exchange for bribes. Ignoring and suppressing warnings from attorneys that the physician contracts were “risky” and raised “red flags” Filing more than 21,000 false claims with Medicare.
Who is a physician under Stark?
Who qualifies as a “physician” subject to Stark? The Phase I final regulations define “physician” as a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine , a doctor of optometry, or a chiropractor.
What is a qui tam relator?
Definition. In a qui tam action, a private party called a relator brings an action on the government’s behalf . The government, not the relator, is considered the real plaintiff. ... For example, the federal False Claims Act authorizes qui tam actions against parties who have defrauded the federal government.
