Stark Law
CONTENTS
Introduction 1
History of Stark Law 2
Key Concepts 3 General Prohibition Under Stark Law 3 Financial Relationships 4 Exceptions 4
Stark Law vs. Anti-kickback Statutes 4
Enforcement of Stark Law 5
Compliance with Stark Law 6 Examples of Problems 6 Compliance Plan 7 Risk of Not Making Repayments 8 Physician Recruitment 9
Conclusion 10
References 11
Introduction
On July 17, 2003 a California Grand Jury filed an indictment against Barry Weinbaum; Tenet Healthsystem Hospitals, Inc.; and Alvarado Hospital Medical Center, Inc. stating the defendants “did knowingly and intentionally conspire with each other and others… to commit offenses against the United States” by soliciting and receiving remunerations and offering and paying remunerations (US v. Weinbaum, Tenet Healthsystem Hospital Inc. and Alvarado Hospital Medical Center, Inc.).
Monday, February 13, 2006: Iowa Methodist Hospital Settles Fraud Claim. “An Iowa lawsuit alleging that Iowa Methodist Hospital pressured physicians to use specific pacemakers in order to get rebates from the manufacturer has been settled…” (MedLaw).
Both of these cases are examples of the enforcement of Stark Law and Anti-kickback statutes. The regulations were designed to “curb fraud and abuse and excessive spending in governmental health care programs” (Brooks). Stark Law or the self referral law prohibits physician from referring Medicare patients for certain health care services to entities with which the physicians or their immediate family members have a financial relationship. The financial relationship can be either an ownership interest or a compensation arrangement (HHS News).
The federal anti-kickback statutes makes it a crime to knowingly solicit, receive, offer or pay any remuneration in exchange for referrals for which payment may be made under a federal health care program such
Introduction 1
History of Stark Law 2
Key Concepts 3 General Prohibition Under Stark Law 3 Financial Relationships 4 Exceptions 4
Stark Law vs. Anti-kickback Statutes 4
Enforcement of Stark Law 5
Compliance with Stark Law 6 Examples of Problems 6 Compliance Plan 7 Risk of Not Making Repayments 8 Physician Recruitment 9
Conclusion 10
References 11
Introduction
On July 17, 2003 a California Grand Jury filed an indictment against Barry Weinbaum; Tenet Healthsystem Hospitals, Inc.; and Alvarado Hospital Medical Center, Inc. stating the defendants “did knowingly and intentionally conspire with each other and others… to commit offenses against the United States” by soliciting and receiving remunerations and offering and paying remunerations (US v. Weinbaum, Tenet Healthsystem Hospital Inc. and Alvarado Hospital Medical Center, Inc.).
Monday, February 13, 2006: Iowa Methodist Hospital Settles Fraud Claim. “An Iowa lawsuit alleging that Iowa Methodist Hospital pressured physicians to use specific pacemakers in order to get rebates from the manufacturer has been settled…” (MedLaw).
Both of these cases are examples of the enforcement of Stark Law and Anti-kickback statutes. The regulations were designed to “curb fraud and abuse and excessive spending in governmental health care programs” (Brooks). Stark Law or the self referral law prohibits physician from referring Medicare patients for certain health care services to entities with which the physicians or their immediate family members have a financial relationship. The financial relationship can be either an ownership interest or a compensation arrangement (HHS News).
The federal anti-kickback statutes makes it a crime to knowingly solicit, receive, offer or pay any remuneration in exchange for referrals for which payment may be made under a federal health care program such
References: Sarraille, A., Kahaner, E., & Spencer, A. Reducing Anti-kickback Risks. Focus on ASCS. Retrieved July 29, 2006, from the World Wide Web. Maruca, William (December, 2000) Compliance and Relationships among Providers [Electronic Version]. Physician’s News Digest. Retrieved July 29, 2006, from World Wide Web: http://www.physiciansnews.com/law/1200maruca.html Pressure Mounts on Hospitals to Reduce Risks of Stark Law Violations (July 3, 2006). AIS Buisness News of the Week. Retrieved July 29, 2006, from the World Wide Web: http://www.aishealth.com/Bnow/070506c.html Summary of Key Aspects of Final Stark II Rule Epstein, Deborah (July, 2004) Stark II Clarifications Bring Sweeping Chages to Recruiting and Referral, MD Options.com. Retrieved July 29, 2006, from the World Wide Web: http://www.mdoptions.com/cgi-bin/article.cgi?article_id=1623 The U.S Koch, Susan (Summer, 2004) Stark II Phase II Adds Clarity to Physician Recruitment Arrangements, [Electronic Version] Health Brief. Retrieved July 29, 2006 from the World Wide Web.