All healthcare businesses and transactions are subject to scrutiny, due to compliance with state and federal restrictions on self-referrals and other prohibited economic relationships. The federal Stark Regulation and Anti Kickback Statute comes into place when any arrangement or relationship involves federal healthcare programs like medicare or medicaid. In addition, California has another statutory rule – that governs healthcare providers business relationships. The repercussions for violations of these statutes can result in criminal and civil penalties, in addition to exclusion from future participation in federal health care programs. As a result, it’s crucial that if you’re a practitioner in Los Angeles – you consult our stark anti-kickback fraud abuse lawyers.
Our lawyers regularly advise healthcare providers when it comes to relationships with other providers, managers, marketing companies, and business entities when it comes to compliance with Stark Laws, Anti-Kickback laws, and other state and federal prohibitions on self-referrals. Ourteam of experienced lawyers are regarded as some of the most highly regarded experts when it comes to the federal physician self-referral statute, the federal anti-kickback statute, and other state law equivalents. Our Los Angeles stark law attorneys have helped a broad spectrum of health care providers and supplies with all aspects of Stark and Anti-kickback laws – including hospitals, and healthcare systems throughout the country.
We provide a full scope of services related to Stark and Fraud issues:
-Structuring and implementing legally sound financial relationships between hospitals, and physicians, in addition to advising on contracts and transactions
-Creating compliance programs, policies, and methodologies, that address Stark and fraud laws
-Unwinding transactions, in order to address new regulations and changing standards
-Hospital/physician joint ventures, M&A’s
-Management agreements and other physician relationship models
-Physician recruit arrangements, developing policies and procedures – in addition to providing counseling advice, and negotiating documents
-Conducting internal audits and investigations to determine whether Stark or fraud has occurred
-Assisting clients with implementing corrective action, including self-disclosure to government authorities when appropriate
The Stark Law is a set of regulations which has been expanded since it’s initial unveiling in 1995. When it was unveiled, it only applied to clinical lab services. Now it refers to a large number of services, collectively known as DHS – designated health services. It also covers any relationship between a physician and the entity which is either performing or billing for the DHS. In summary, physicians are prohibited from referring DHS payable by Medicare or Medicaid to any organization which the physician has a financial relationship with. Penalties include denial of payment, refund of payment, an imposition of a $15,000 per service civil penalty, or a $100,000 civil penalty for each circumvention scheme. Our Los Angeles stark abuse lawyers can help you understand whether the Stark Law applies to your existing, or new, relationships, and whether there are exceptions available. If no exceptions exist, our Los Angeles stark anti fraud lawyers can help you structure your contracts and policies to comply with Stark. We highly recommend you review your relationship, and policies, on an annual basis to make sure your relationships, and the DHS you perform, have not changed accordance with the laws.
Penalties for violating Stark
Penalties are severe. It can include denial of payment, refund of the payment, imposition of a $15000 per service civil monetary penalty, or an imposition of a $100,000 civil monetary penalty for each arrangement that is deemed to be a circumvention scheme.
Who qualifies as a physician
The Phase I regulation define physician as a DO or MD, a DDS, or DM, DP, Doctor of Optometry, or Chiropractor.
What is DHS
DHS stands for designated health services. This means services like equipment, supplies, and drugs as well. The physician is prohibited from self-referrals. The following are examples of items, and services, referred to as DHS:
-Clinical lab services
-Occupational therapy services
-Speech language pathology services
-Radiology and other imaging services
-Radiation therapy services / suplies
-Durable medical equipment
-Parenteral and enteral nutrients/equipment/supplies
-Prosthetics, orthotics, devices, supplies
-Home health services
-Inpatient and outpatient services pertaining to hospitals
What exceptions are available
There are numerous exceptions to Stark. The In-Office Ancillary services exception, the Whole Hospital Exception, the Bona Fide Employment Exception, and many more. Each exception has elements which have to be complied wit, in order for the exception to be granted. If one or more of these elements isn’t met, then there is a violation. It means it’s crucial you speak to our Los Angeles stark fraud and abuse lawyers to analyze, and understand, evert aspect of your provider relationship.
Does Stark require notification if a physician has a relationship with a provider
If a physician is referring diagnostic testing under the In-Office Ancillary Services Exception, then the physician has to provide notification to the patient at the time the referral happens. The notification must mention the patient isn’t obligated to get the services from the facility. The notice should also include 5 facilities within a 25 mile radius of the office.
If i’ve violated Stark what can I do
The law requires any person whose received an overpayment to report and return it – and notify the entity to who the overpayment was returned — with a written document describing the reason for the overpayment. It has to be reported and returned within 60 days of discovery of the overpayment. Any entity which retains an overpayment after the window can be charged under the False Claims Act (31 U.S.C. §3729). This can result in large civil monetary penalties, treble damages, and exclusion from other federal health care programs.
The CMS has also established a medicare self-referral disclosure protocol. Under it, providers can self-disclose violations and the CMS can reduce the amount for the violation.