Stark Law Violation Attorney

Today’s Stark Law Violation Attorney faces the special challenge of transversing the ever-expanding scope of the federal physician self-referral law typically referred to as the Stark Law. Initially passed in 1989, the original purpose of the Stark Law was to clearly identify improper use of self-referred diagnostic services as established by the Centers for Medicare & Medicaid Services, the regulatory institution of the Stark Law. In 1993, the definition of “services” was extended to include a variety of other health services reimbursable through the Medicare program. Under the Stark Law, physicians are forbidden to make referrals for designated health services which may be reimbursed through Medicare to a person or institution with which the physician has a fiduciary relationship. This includes both the entity that presents a claim for service before Medicare as well as the entity that actually performs the service, regardless if another entity bills for the service. The Stark Law Violation Attorney will need the ability to discern the fiduciary relationship between the referring physician and all other parties.

There are several exceptions to the Stark Law physician self-referral ban. The Stark Law Violation Attorney must be able to recognize these exceptions in order to effectively counsel his clients in this era of rapid Stark Law expansion. An example of a Stark Law exception is the In-Office Ancillary Services rule permitting physicians to refer certain services that fall within the spectrum of the physician’s medical practice. In-Office Ancillary Services may include pharmacy, radiology, and physical therapy procedure. The Centers for Medicare & Medicaid Services has proposed that physicians provide full disclosure to their patients regarding the fact that these In-Office Ancillary Services can be obtained by other providers. The proposal states that, as of January 1, 2011, physicians are required to provide a written list of alternate providers for these services. The Stark Law Violation Attorney needs to consider the fact that there may be future limitations to the In-Office Ancillary Services exception. Another exception of which to be mindful is the Whole Hospital exception that permits physicians to have ownership benefits in a hospital providing those benefits are not department specific.

Drakeford v. Toumey Healthcare System, Inc. is a good example of the complex nature of the Stark Law limitations and requirements. The Stark Law Violation Attorney would benefit from being up-to-date regarding the changes and updates in physician self-referral regulations.


November 15th, 2010