The Stark Law explained

You take an oath when you become a healthcare provider in Texas in which you promise to provide the best possible care to your patients. Often such care requires resources, not at your immediate disposal (or assistance with care for a clinical field outside of your particular area of expertise). Patient referrals, however, can often open the door to potential infractions.

Many in your same position come to us here at Hilder & Associates, P.C. facing such infractions after allegedly running afoul of the Physician Self-Referral Law (also known as “the Stark Law”). If your actions result in similar accusations, successfully defending yourself requires knowing exactly what this statute does (and does not permit).

Be wary of your financial relationships

Oftentimes the professional relationships you establish progress to actual business partnerships (in which both you and your partner may profit from a shared transaction). In the case of medical care, the Stark Law prohibits you from referring a patient to receive “designated health services” rendered by a provider or facility with whom you have an existing financial relationship. The Office of the Inspector General defines “designated health services” as things such as:

  • Clinical lab work
  • Imaging services and radiation therapy
  • Prosthetics, orthotics, and durable medical equipment
  • Home health care
  • Physical, occupational and speech therapy
  • Standard inpatient and outpatient hospital services

Exceptions to the Stark Law

There are, however, certain exceptions to the Stark Law which allow you to make referrals even which such a referral is to an entity with which you have a financial connection. This includes referrals for cochlear/intraocular implants from an ambulatory surgical center (or clinical lab services from an ASC or an end-stage renal disease facility) or services provided at an academic medical center for which you are an employee.

You can find more information on healthcare fraud defense on our site.