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Stark Law Compliance Programs

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Physicians who understand the importance of following Stark Law may wonder if setting up a compliance program for their practice is a good idea. There may be benefits for doing so, but there are also questions that should be addressed first. There are currently five major federal fraud and abuse laws that every physician should be familiar with:

  • Anti-Kickback Statute (AKS)
  • Civil Monetary Penalties Law
  • Exclusion Authorities
  • False Claims Act
  • Physician Self-Referral Law (Stark Law)

These laws are enforced by the Department of Health & Human Services Office of Inspector General, the Centers for Medicare & Medicaid Services, and the Department of Justice. Violators are subjected to loss of medical license, civil fines, criminal penalties, and being excluded from federal health care programs.

Stark Law prohibits doctors from referring their patients for designated health services payable by Medicaid or Medicare from providers that they or a family member have financial relationships with. This could include home health care companies, imaging services, and lab services. However, there are exceptions that fit into the law.

Is a Compliance Program Necessary?

There are companies that design compliance programs and make them available for purchase. Some are more generic, and others are more tailored and appropriate for larger practices. Once set up, these programs must be followed carefully and complied with at all times; otherwise, it will be a waste of valuable resources. The larger a medical practice is, the more difficult it can be to monitor adherence to Stark Law and other regulations. Depending on the size, scope, and type of practice, it may be worthwhile to start a compliance program to prevent violations.

Stark Law only applies to certain federal entitlement programs, Medicaid, Medicare, and CHAMPUS, so physicians who do not participate should not be concerned. It is also only used against physicians and immediate family members in positions to make referrals. For example, if a physician referred a Medicaid patient for lab work to a clinic owned by their own husband, this could be a problem. If that referring physician has a financial interest in the referral to the clinic, it could be seen as a violation.

It is also important to know that most states have their own laws against self-referrals, and these may be more strict than federal laws. To complicate matters further, Stark Law and the AKS address related issues, and Stark Law exceptions have changed over time.

Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Protect Physicians from Stark Law Violations

Your practice is your most valuable asset, and the Philadelphia physician lawyers at Sidney L. Gold & Associates, P.C. make its protection their priority. For a free consultation, call us at 215-569-1999 or complete our online form. Located in Philadelphia, we serve physicians throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.

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