Under provisions of the Stark Law, also known as the self-referral law, for health-care providers, a doctor may not refer a Medicare or Medicaid patient to another provider for the provision of designated health services if the doctor or an immediate family member has a financial interest in the other provider.
If you are contemplating entering a transaction involving designated health care services, it is important to obtain experienced legal counsel. The lawyers of Hendershot, Cannon, Martin & Hisey provide knowledgeable legal counsel for healthcare professionals who are contemplating or entering into a transaction governed by the Stark Law.
Our firm handles healthcare law matters and serves the medical community in Houston and throughout the United States. Call (713) 909-7323 to discuss your specific issue.
The Stark Law applies to designated health care providers. They are:
If you have questions about whether the Stark Law applies to you, we can help. Our attorneys have more than 200 years of experience advising and representing health-care providers on compliance, Medicaid and Medicare fraud investigations, and other situations in which the Stark Law applies.
Before entering into any designated healthcare transaction that may fall under Stark, it is important to determine whether any of the available exceptions apply, including:
Our law firm can advise you whether exceptions may apply to your transaction. We will explain the law, including examining the safe harbors and exemptions that are included in the law. We will help you set up designated healthcare service transactions that comply with Stark. If your healthcare organization is accused of violating the Stark Law, we can advise you and defend you in related administrative proceedings.
Physicians can accidentally violate the Stark Law because of the low degree of intent to commit fraud required for a violation. The Anti-Kickback Statute, for example, takes into account intent to commit fraud by purposefully referring Medicare and Medicaid patients to an affiliated clinic, then avoiding the anti-markup statutes when billing the Centers for Medicare and Medicaid Services (CMS).
The Stark Law, however, does not recognize that a physician may not realize that a financial relationship exists. Under provisions of Stark, if the government can prove that the doctor will benefit financially from the referral for outside diagnostic or lab services, CMS will not be required to pay-regardless of innocent intent.
If you realize that you have inadvertently violated provisions of the Stark Law, the Office of the Attorney General (OAG) makes it possible to negotiate a financial settlement that is typically substantially less than the total amount that may be required for full restitution. If the OAG investigates and discovers that you were aware of the financial relationship with the outside service provider, you will face full restitution, plus penalties and interest on the money repaid to the government.
Negotiating a fair settlement with the OAG requires knowledge of the Stark Law, extensive record keeping of timelines for referrals and payments, and a firm understanding of what the attorney general will accept. The health law team at Hendershot, Cannon, Martin & Hisey has decades of experience representing physicians and health-care providers in all areas of Medicare and Medicaid billing. Our Houston health law attorneys work aggressively with the OAG to negotiate the lowest repayments possible and fight aggressively to avoid criminal penalties stemming from anti-kickback and Stark Law violations.
Consult with a Texas health & medical law attorney at Hendershot, Cannon, Martin & Hisey today.