Violations of the Stark Law

 Posted on February 22, 2022 in Medical License Defense

There are many federal and state laws that physicians are required to abide by, including laws that address fraud and abuse. According to the Office of Inspector General, U.S. Department of Health and Human Services (OIG), the most serious of these laws include the Physician Self-Referral Law (Stark Law), the Anti-Kickback Statute (AKS), and the False Claims Act (FCA). Violations of these laws can result in severer penalties, including exclusion from federal health care programs, civil fines, loss of medical license, and even criminal penalties. In our next few posts, we will discuss each of these laws and how they may affect your practice. In this post, we will look at the Stark Law.

The Physician Self-Referral Law

The Physician Self-Referral Law, referred to as the Stark Law, bans doctors from referring patients to other medical providers for services that will be paid by Medicare, Medicaid, or other programs if the referring doctor or a member of their immediate family has any type of financial relationship with the medical provider they are referring. Basically, a doctor cannot refer a patient in exchange for receipt from that provider of anything of value. They also cannot present claims to Medicare or other healthcare program for referred services.

The Stark Law is meant to protect patients from procedures – and medical expenses – that are unnecessary. It also applies to all medical facilities, whether a small private practice or a large health care system. There are some exceptions to the Stark law, however, those exceptions are very limited.

All of the following medical services are covered under the law:

• Both inpatient and outpatient hospital services

• Home health services

• Imaging services

• Laboratory services

• Medical equipment

• Nutrient supplies and equipment

• Occupational therapy

• Orthotics, prosthetics, devices, and supplies

• Outpatient prescription medications

• Outpatient speech/language services

• Physical therapy

• Radiation therapy

Penalties for Stark Law Violations

Although Stark Law violations are only considered civil violations and not criminal, if a doctor is found guilty of violating the law, the penalties are still harsh.

The physician can be fined up to $15,000 for each violation. They can also be charged up to $100,000 for each “circumvention scheme” they used to get around the law.

All payments received by the doctors and medical facilities are required to be refunded. In addition, the doctor will be responsible for triple the amount of the improper payment that the government paid for the medical services.

They will also be excluded from Medicare, Medicaid, and other state healthcare programs.

Contact an Illinois Professional Medical License Defense Attorney

If you have been accused of violating this or any other federal law, your medical practice and future could be in serious jeopardy. Call The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to speak with one of our skilled Illinois Stark Law violations attorneys today. 

Sources:

https://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/index

https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/