The Stark Law (The Health in Patient Referrals Act) is designed to prevent physicians from referring patients for certain health care services paid for by federal health care programs (Medicare and Medicaid) to facilities that have a financial relationship with the physician. The law is a fraud and abuse law that seeks to stop physicians from benefiting financially from referrals to facilities in which the doctors own or have investment interests. The law also applies to facilities in which the physician’s immediate family members may own or have an investment interest. Examples of facilities that are covered under the Stark Law include physical therapists, labs, hospitals, other physician’s offices, and radiologists.
While the Stark Law is not a criminal statute, physicians who violate the statute could be charged substantial penalties. In some cases, a physician could also face criminal charges under federal anti-kickback statutes. Therefore, it is important to understand what is covered by the Stark Law. It is also important to work with New York criminal defense attorney serving doctors if you have received notice of Stark Law violations.
Common Reasons Why Physicians Face of Stark Law Violations
The law prevents physicians from receiving a financial benefit by referring Medicaid and Medicare patients for certain Designated Health Services (DHS). Examples of DHS that are covered by the Stark Law include, but are not limited to:
- Radiation and radiology services
- Home health services
- Clinical laboratory services
- Durable medical equipment and supplies
- Outpatient and inpatient hospital services
- Occupational, physical, or speech therapy
- Outpatient prescription drugs
A DHS provider who receives a prohibited referral from a physician is barred from submitting a claim to Medicare or Medicaid for payment.
Violations of The Stark Law Can Be Confusing
There are numerous exceptions to the Stark Law. For example, a physician in a group practice may refer a patient for in-office ancillary services such as radiology or laboratory services. Another exception is if the referral is to a facility that is not considered a Designated Health Service (DHS). There is also a fair market compensation exception, an indirect compensation exception, and a non-monetary exception, among other exceptions.
Even though a physician may make a referral that falls within one of the exceptions to the Stark Law, that physician could be violating the federal anti-kickback statutes if the physician receives remuneration for the referral. Experienced New York physician defense attorneys can provide guidance and legal counsel on whether a referral violates any anti-kickback laws.
New York Criminal Defense Attorneys
Strict liability applies to Stark Law violations. Therefore, it is not a requirement that the government proves the physician intended to violate the law. A physician who unknowingly or accidentally referred a patient in violation of the Stark Law could face severe civil penalties.
Because of the severity of the law, physicians must be incredibly careful to have extensive conflict checks in place to avoid a Stark Law violation. Contact the Sacco Tyner team today to discuss how we can help you avoid costly Stark Violations. One of the best ways to ensure a physician complies with the Stark Law is to work closely with and frequently consult with New York physician defense attorneys who have experience defending Stark Law violations.
Posted in: Criminal Defense