Pennsylvania Health Care Lawyers for Stark Law Violations

The Stark Law [CITATION] is a federal statute that prohibits a physician from referring their Medicare patients for services (such as diagnostic testing and blood work) to a place in which the physician, his/her medical practice, or an immediate family member has an existing financial relationship. The physician or health services entity may not submit claims to Medicare for reimbursement for those services resulting from a prohibited referral.   Unlike other anti-kickback statutes, the Stark Law only applies to referrals from physicians, not other medical care providers. By avoiding financial incentives to order more services than necessary, the Stark Law seeks to avoid an over-utilization of medical services by physicians.

Designated Health Services

Under the Stark Law, physicians can not refer “designated health services” (“DHS”) to entities with which they or their immediate family members have a financial relationship.  These designated medical services include:

• Radiology and imaging services
• Clinical laboratory services
• Occupational therapy services
• Physical therapy services
• Speech-language pathology services
• Radiation therapy services
• Durable medical equipment and supplies (walkers, wheelchairs, canes, crutches, hospital beds)
• Home health services
• Prosthetics devices and supplies
• Prescription medications
• Inpatient and outpatient hospital services

Stark Law Exceptions

Federal law allows certain Medicare referrals even when an existing financial relationship between the referring physician and the medical services provider exists. The mandatory exceptions to the ban on self-referrals include certain written agreements which include:

• In-office ancillary services agreements
  A physician can refer a Medicare patient to another physician who is a member of the same group practice for treatment or testing if that treatment or test is conducted in the same building used by the group practice.  Many academic medical centers rely on this exception to coordinate patient medical care among each other.

• Professional courtesy services
  Providers may provide physicians and their immediate family members with free or discounted services under certain circumstances.

• Compensation/employment agreements
  Fair market value compensation arrangements, bona fide employment arrangements and limited non-monetary compensation benefits (valued at up to $300) may also qualify as Stark Law exceptions.

• Other written agreements
  Lithotripsy arrangements, certain office space and equipment rental arrangements, and personal service arrangements also fall within the Stark Law exceptions.

Civil Penalties

Violations of the Stark Law can result in criminal sentences including imprisonment, an obligation to repay Medicare funds imposition of  civil penalties of $15,000 per service, and  civil penalties of $100,000 for each prohibited arrangement.  Physicians may be required to repay and reimburse Medicare for all payments received from their referrals during the period of non-compliance and civil assessments may be imposed for up to three times the amount claimed.

Pennsylvania Health Care Lawyers Represent Physicians Concerned About Stark Law Violations

The experienced Pennsylvania health care lawyers at Michelman & Bricker, P.C. assist health care law practitioners with all their business and litigation needs including the counseling and defense against Stark Law claims. Our dedicated Philadelphia health care lawyers help medical providers work proactively to ensure compliance with all federal Medicare and Medicaid regulations, including Stark Law requirements and health care licensing issues. In addition to providing extensive regulatory analysis and strategic business planning advice, contract drafting and employment-related matters, our Philadelphia health care lawyers bring their white-collar criminal defense experience to handling all of your health care-related litigation needs.