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The Stark Law and Anti-Kickback Statutes

Assisting providers in navigating regulatory pitfalls throughout the United States

In practicing medicine, dentistry and allied health professions, health care providers must maneuver and understand numerous regulations beyond simple fraud and abuse statutes. Among these are the federal Anti-Kickback Statute, the physician self-referral prohibition — more commonly called the Stark Law — and state anti-kickback and referral laws and regulations, which may differ from the federal laws. At Buttaci Leardi & Werner, LLC, our attorneys can help you determine the regulatory hazards and legal traps so your business and your practice can thrive. We help group practices, physician-owned distributorships, hospitals, diagnostic laboratories, and other individuals and entities grow and thrive in the health care regulatory climate.

The Stark Law and its effects

The Stark Law — prohibiting physician self-referrals — was originally passed in 1995. Originally designed to protect against clinical laboratory self-referrals, it now applies to a wide variety of Designated Health Services (DHS) and practically any monetary relationship between a health care provider and the entity billing or providing the DHS.

Under the Stark Law, providers are prohibited from referring Medicare-paid or Medicaid-paid DHS to any facility that shares a financial relationship with the provider or the provider’s immediate family. There are a limited set of exemptions, including in-office ancillary services, prepaid plans and intrafamily referrals, for example. The penalties for violating the Stark Law are stark:

  • Denial of payment by Medicare or Medicaid
  • Refund of previous payments
  • $15,000 per service civil monetary penalty
  • $100,000 per circumvention scheme arrangement civil penalty

At Buttaci Leardi & Werner, our attorneys work with you to determine if your practitioner relationships fall under the Stark Law and whether there is an exemption available. We’ll review and structure relationships and contracts to ensure you remain in compliance.

Federal and state anti-kickback laws

Most situations involving the Stark Law must also be scrutinized under the federal anti-kickback statute and its state counterparts. In essence, these statutes penalize — as a crime, a civil offense, or both — individual practitioners and practice groups that offer, pay, solicit or receive compensation to obtain patients who are treated by Medicare, Medicaid or private insurers. When the federal laws apply to Medicare and Medicaid, state anti-kickback and self-referral laws apply to all payers, such as private insurers, self-pay patients and others. Attorneys at Buttaci Leardi & Werner are here to assist you in addressing, complying and understanding these and other health law issues.

Contact us about our Stark and anti-kickback practice

To learn more about Buttaci Leardi & Werner’s Stark and anti-kickback practice, please contact us online or call us at 609.297.5942.