Most regulatory healthcare laws govern the way a physician is reimbursed. This is not limited to treating a patient. Almost anything governing a physician’s or health care establishment’s financial interests are governed by State and Federal Laws.
Stark law governs physician self-referral and is one of the most notable statutes affecting physicians personally. If a physician (or a close family member) has a financial stake in a medical facility, Stark law governs how those patients are referred to such facilities. A “financial stake” could mean full ownership, partial ownership, significant investment, or some other arrangement. For example, if a patient visits their primary care physician and he recommends an MRI, he could not, under Stark, refer that patient to an imaging center where he has 50/50 partnership with his brother, unless an exception applies.
This law was first effective back in 1992 and has undergone many phases and amendments, including as recently as 2008. Physicians constantly seek attorney consultation on their innovative business practices and most of the solutions are found after carefully reviewing Stark law and Anti-Kickback Statutes (AKS). Such laws were meant to combat potential conflict of interest issues and overutilization of services that are responsible for driving up health care costs. However, most physicians and their attorneys know that many referrals and business practices of physicians are done in good faith. This is why there are many exceptions and caveats to this long and complex law that has often been amended since its inception. Unlike AKS, this is strictly civil and penalty for violation would be limited to fines. However, the fines can be very steep as they may be assessed per violation.
We, at Midwest Legal Partners ensure that our clients receive the best advice to prevent violation of this statute. We also advise on how our clients can take its exceptions and allow them to operate their practices in a way that is financially beneficial and medically ethical.
Click below for more information on our Healthcare Law practice:
Anti-Kickback Statutes and Fraud and Abuse
Recovery Audit Contractors and other Government Audits
Insurance Coverage and Other Forms of Reimbursement
HIPAA and Advances in Health Information Technology
Medical Malpractice Defense
Running Your Own Practice