Breaking down the Stark Law

Past posts on this blog touched upon the fact that you (as a healthcare provider) cannot receive compensation for referrals made to other practitioners in Texas. At the same time, most people understand the need to refer patients to other doctors in order for them to receive the highest level of care.

Even still, many clinicians come to us here at Hilder & Associates, P.C. facing allegations of receiving improper kickbacks. If you also face such accusations, it is important you understand the regulations governing physician referrals in order to answer to such claims.

The Physician Self-Referral Law

The formal title of this particular statute is the Physician Self-Referral Law. Most, however, know it by its more common name: the Stark Law. This law prevents you from referring patients for designated health services payable by both Medicare and Medicaid to providers with whom you (or one of your family members) has an existing financial relationship. According to the Office of the Inspector General, “designated medical services” in this context refer to elements of care such as:

  • Inpatient and outpatient care
  • Radiation therapy and general radiology services
  • Therapeutic services (including physical, occupational and speech-language pathology services)
  • Clinical laboratory services
  • Prescriptions
  • DME, prosthetics and medical supplies

Exceptions to the Stark Law

There are, however, certain exceptions to the Stark Law. These include services referred to a physician that either belongs to your same physician group or practices within your same clinic. In addition, you can refer patients for services to an academic medical center if you are a bona fide employee of the center, practice as a member of the academic faculty, and receive compensation for the services you provide to the medical center.

You can find more information on answering to accusations of healthcare fraud throughout our site.