Quick Answer: Do Stark Laws Apply To Employed Physicians?

How does the Stark law impact physicians?

The Stark Law, also known as the physician self-referral law, prohibits a physician from referring Medicare or Medicaid patients for certain designated health services in which that physician (or the physician’s family member) maintains a financial interest..

Do dentists get kickbacks from orthodontists?

#10: You may not need that root canal, even though your dentist suggests it—dentists receive kickbacks when they refer you to an endodontist, who will most likely perform a root canal.

Who does Stark law protect?

The Stark law prohibits a physician’s referral for certain designated healthcare services (DHS) to an entity if the physician (or a member of the physician’s immediate family) has a financial relationship with the entity, unless the referral is protected by one or more exceptions provided in the law.

What is an example of the Anti Kickback Statute?

Classic examples of violations of Anti-kickback and Stark laws include: … Drug companies paying kickbacks to insurers to get on their formularies; Payments by specialty pharmacies, DME suppliers, therapy centers, nursing homes, etc. to patient recruiters or to patients directly.

Does Stark law only apply to physicians?

The Stark statute applies only to physicians who refer Medicare and Medicaid patients for designated health services to entities with which they (or an immediate family member) have a financial relationship. There are almost 20 exceptions to the Stark statute.

What is the difference between the Stark Law and the Anti Kickback Statute?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

Does Stark law apply to chiropractors?

The Stark Law applies to physicians but the Social Security Act defines a physician as a dentist, MD, DO, optometrist, and a chiropractor. … Under the Stark Law, an entity is broadly defined and includes an organization that bills the Medicare Program or performs a DHS.

How does the Stark law impact physicians quizlet?

How does the Stark Law impact physicians? The Stark Law prohibits a physician from referring a patient for certain “designated health services” to an entity with which the physician has a “financial relationship.” In addition, a provider may not bill Medicare for a claim based upon a prohibited referral.

Can a physician own a physical therapy practice?

POPTS stands for physician-owned physical therapy services. … As such, physicians typically refer patients who need PT to a therapist within their own clinic. As you can imagine, this setup can be very lucrative for physicians.

In what situation is a written agreement not required under Stark?

For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R. 411.357.

What is a safe harbor under the Anti Kickback Statute?

The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances.

What is the purpose of the Anti Kickback Statute?

The AKS is a criminal statute that prohibits transactions intended to induce or reward referrals for items or services reimbursed by the federal health care programs.

Who is a physician under Stark?

Who qualifies as a “physician” subject to Stark? The Phase I final regulations define “physician” as a doctor of medicine or osteopathy, a doctor of dental surgery or dental medicine, a doctor of podiatric medicine, a doctor of optometry, or a chiropractor.

Does Stark law apply to pharmacies?

The Stark Law applies to all relationships that physicians have with designated health services entities, and pharmacies are classified as such. Because of this, referral relationships between physicians and pharmacists can be scrutinized through the lens of the Stark Law.

What is a safe harbor under the Stark Act?

Proposed Stark Law Safe Harbors VBAs in which the VBE assumes full financial responsibility for the cost of all patient care items and services; VBAs in which a physician faces “meaningful,” but not full, financial risk; … Arrangements that involve the donation of cybersecurity technology and services.

Can physicians own pharmacies?

AMA Ethics Opinions Under 8.06(3) Physicians may own or operate a pharmacy, [note: check state law for licensing rules details] “but generally may not refer their patients to the pharmacy” unless exceptional circumstances under Opinion 8.032 (conflict of interest) exist.

Does Stark law apply to dentists?

By its express terms, the Stark Law applies to dentists, including them within the definition of “physician.” As a practical matter, however, the Stark Law is limited in its reach to orthodontists and other dental practitioners because Medicare does not cover most dental services.

What does the Stark law prohibit?

The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

Can doctors recommend a pharmacy?

Can a physician own, or own interest in, a pharmacy? Yes. However, there must be no conflict of interest.