The federal Anti-Kickback Statute (AKS) prohibits the exchange of a reward for the referral of a federal health care program or business. Like AKS, Stark Law prohibits physician self-referral of a Medicare or Medicaid patient to an entity providing designated health services with whom the physician has a financial relationship.
For example, certain doctors who invest in healthcare ventures with outside parties such as imaging centers, laboratories, physical therapy clinics, or equipment vendors, refer more patients to those entities than physicians who do not invest. These excessive and medically unnecessary referrals cost the federal government and would normally have legal risks under AKS and the Stark Law.
Providers Move to Value-Based Care
However, those in the healthcare industry think the government should encourage arrangements that incentivize the referral of Medicare and Medicaid patients to care providers. With value-based arrangements that reward care coordination and economic savings, it is evident that the healthcare industry is moving toward a system that pays for value instead of volume.
The Centers for Medicare and Medicaid Services (CMS) published a request for information (RFI) in the Federal Register seeking input from health care industry stakeholders on Stark Law provisions that concern obstacles in coordinating arrangements and what exceptions and protections are needed for alternate payment models. The purpose of the RFI is to determine how it can minimize the regulatory barriers of federal anti-kickback laws and support providers as they move to value-based care.
Modifications and Transparency
The Stark Law also contains certain provisions that may need to be adjusted. The CMS is looking for the following terms to be reviewed for Stark Law purposes:
- Defining commercial reasonableness
- Modifications of fair market value
- When physicians consider the volume or value of referrals in relation to compensation between parties
The RFI also expresses concerns of transparency in relation to a physician’s financial relationships and data availability reducing the harm toward Medicare programs.
Philadelphia Health Care Lawyers at Sidney L. Gold & Associates, P.C. Help Resolve Legal Matters for Physicians
If you are a physician who has been sidelined by the specific set of business and legal issues connected to medical professions, contact a Philadelphia health care lawyer at Sidney L. Gold & Associates, P.C. for assistance. It is crucial for health care providers to have quality legal counsel for such issues as regulatory compliance. We help our clients keep their medical licenses in good standing. Conveniently located in Philadelphia, we proudly serve clients from the surrounding areas, including Bucks County, Chester County, Delaware County, and Montgomery County. For a free consultation, contact us online or call us today at 215-569-1999.