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Los Angeles stark law anti kickback fraud abuse lawyer

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

 

Make sure you’re compliant

Health care providers must remain compliant with regulations, like the Stark Law, the Anti-Kickback statute, and the number of state fraud/abuse rules which may or may not mirror federal laws. We’ve helped providers, such group practices, hospitals, physician organizations, and other diagnostic testing facilities to name a few. Regardless of what your healthcare business is, our attorneys can help you uncover regulatory pitfalls – and ensure you’re conducting business in a way that is compliant with healthcare fraud laws and regulations.

Stark Law

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

-PT 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

-Outpatient drugs

-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.

 


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Charle Butler
Charle Butler
2021-03-12
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I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
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debabrata chakraborty
2021-03-03
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Asata Hendricks
2021-03-02
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Mike Moroff
Mike Moroff
2021-02-26
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I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
Josh Katz
Josh Katz
2021-02-24
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Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
L.C.
L.C.
2021-02-24
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I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
AnnMarie Soliman
AnnMarie Soliman
2021-02-23
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I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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