Who Is A Physician Under Stark?

Who does the Anti Kickback Statute apply to?

The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of ….

What is the purpose of the Anti Kickback Statute?

The AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs.

Does Stark law apply to dentists?

By its express terms, the Stark Law applies to dentists, including them within the definition of “physician.” As a practical matter, however, the Stark Law is limited in its reach to orthodontists and other dental practitioners because Medicare does not cover most dental services.

What is the 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.

What is the difference between Stark and Anti Kickback?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

What are illegal provider relationships?

The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.

What is an illegal kickback?

A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value.

What is a safe harbor under the Anti Kickback Statute?

The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances.

Does Stark law apply to pharmacies?

The Stark Law applies to all relationships that physicians have with designated health services entities, and pharmacies are classified as such. Because of this, referral relationships between physicians and pharmacists can be scrutinized through the lens of the Stark Law.

Do Stark laws apply to employed physicians?

Both the Stark Law and the Anti-Kickback Statute contemplate employment of physicians by hospitals, and accordingly, both include an exception to accommodate the compensation paid by a hospital employer to a physician employee.

How does physician self referral or Stark laws apply to Medicare payments?

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.

What is a safe harbor under the Stark Act?

Proposed Stark Law Safe Harbors VBAs in which the VBE assumes full financial responsibility for the cost of all patient care items and services; VBAs in which a physician faces “meaningful,” but not full, financial risk; … Arrangements that involve the donation of cybersecurity technology and services.

Can a physician own a hospital?

A physician-owned hospital is now generally prohibited from expanding facility capacity. … However, a physician-owned hospital that qualifies as an applicable hospital or high Medicaid facility may request an exception to the prohibition from the Secretary.

Why is stark law important?

The Stark Law, and closely-related Anti-Kickback Statute, were important regulations 30 years ago designed to protect the patient community from fraud and abuse. … The Stark Law may prevent these very relationships and incentives that are designed to improve quality, and reduce waste under a modern healthcare system.

What does Stark stand for?

healthcare fraud and abuse lawThe Stark Law is a healthcare fraud and abuse law that prohibits physicians from referring patients for certain designated health services paid for by Medicare to any entity in which they have a “financial relationship.” The federal government interprets the term “financial relationship” broadly to include any direct …

What are the exceptions to the Stark law?

Vaccines, immunizations, and screening tests are generally allowable Stark exceptions provided they aren’t given too often. The tests must be covered by Medicare. Intra-family rural referrals. Additionally, some referrals in rural areas are allowed if the services are for an immediate family member.

How does the Stark law impact physicians?

The Stark Law, also known as the physician self-referral law, prohibits a physician from referring Medicare or Medicaid patients for certain designated health services in which that physician (or the physician’s family member) maintains a financial interest.

In what situation is a written agreement not required under Stark?

For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R. 411.357.