Stark Law is a set of United States federal laws that prohibit physicians' self-referrals, especially referrals by Medicare patients or Medicaid doctors to specialist health-care entities ("DHS") if doctors (or family members close) has a financial relationship with that entity.
The term "referral" means "request by physician for goods or services" for Medicare service Part B and "request or manufacture of treatment plan by physician that includes provision of established health care" for all others. services. DHS includes "clinical laboratory services"; "physical therapy services"; "occupational therapy services"; "radiology services, including magnetic resonance imaging, computerized axial tomographic scans, and ultrasound services"; "radiation therapy services and supplies"; "durable medical equipment and equipment"; "parenteral and enteral nutrition, equipment, and supplies"; "prosthetics, orthotics, and prosthetic devices and supplies"; "home health services"; "prescription drug outpatient"; "inpatient and outpatient hospital services"; and "outpatient language speech pathology service." "Financial relationship" includes ownership, investment interest, and compensation arrangements.
Stark's law contains several exceptions, including physician services, additional office services, in-securities holdings and openly traded mutual funds, office space leasing and equipment, and bona fide working relationships. Named for US Congressman Pete Stark (D-CA) who sponsored the initial bill.
Video Stark Law
History
In 1988, Stark introduced the law "Ethics in Patient Referrals" about self-referrals doctors. Some ideas in the bill became law as part of the Omnibus Budget Reconciliation Act 1990. In particular, the so-called "Stark I" prohibits a doctor from referring a Medicare patient to a clinical laboratory if the doctor or his/her family member has a financial interest in the laboratory. It is codified in the United States Code, Title 42, Section 1395nn (42 U.S.C. 1395nn, "Restrictions on referrals of a particular physician").
The 1993 Omnibus Reconciliation Act contains what is known as the "Stark II" amendment to the original law. "Stark II" extended the provisions of "Stark I" for Medicaid and DHS patients in addition to clinical laboratory services.
The Medicare and Medicaid Service Centers have issued rules in the Federal Register to apply Stark Law, including the final rule "Phase I" 2001, the temporary final rule "Phase II" 2004, and the final "Phase III" 2007 rule.
Maps Stark Law
Penalty
Penalties for violation of Stark Law include: denial of payment for a given DHS; refunds received by doctors and facilities for the amount collected; the payment of a civil penalty of up to $ 15,000 for any service "known or known" by a person is unlawful, and three times the amount of inappropriate payment received by the entity from the Medicare program; exclusion of Medicare programs and/or state health programs including Medicaid; and civil penalty payments to try to avoid the law up to $ 100,000 for any circumvention schemes.
Self-referral doctor
An independent referral physician is a physician's practice of referring a patient to a medical facility where the physician has a financial interest, be it ownership, investment, or a structured compensation arrangement. Critics argue that this practice is an inherent conflict of interest, because doctors benefit from doctor referrals. They suggest that such arrangements may encourage excessive use of the service, which in turn increases health care costs. In addition, they believe that it will create a captive referral system, which limits competition with other providers.
Those who maintain the practice argue that these issues are not widespread. They argue that physicians who own, invest, or operate medical facilities respond to the need for medical services that will not be met, especially in less-served areas. In addition, it is often the case that entity-owned doctors present a low-cost alternative to hospital-centric facilities. This is largely due to the higher overhead costs that hospitals need to pass on to their services.
Enforcement
Some federal entities oversee Stark Law enforcement. These include the Department of Justice, CMS, and the Department of Health and Human Services. In recent years, Stark Law enforcement has become increasingly aggressive, largely as a result of the Patient Protection and Affordable Care Act and its amendments to the False Claim Act.
2014 saw some of the biggest violations of Stark's law offenses to date. On June 9, 2015, the Office of the Inspector General issued a fraud alert targeting doctors' compensation arrangements with hospitals and the health system.
Risk reduction
Contracts between doctors and hospitals must comply with the seven safe ports for Stark's Law in order to fully mitigate the risk of violation: the duration of the contract should be at least a year; in writing and signed by both parties; specify pre-determined aggregate payments; payment is fair and fair market value; payment must not be related to volume or business value; the exact service to be performed should be described; and commercially reasonable. Since the current process for monitoring contract compliance and working hours of logging physicians is often done on paper, the majority of violations of the Stark Law violations are a result of technical violations.
Health experts agree that information technology is needed to streamline hospital processes, including those related to compliance and Stark Law. Certain electronic health record companies help the health system collect, organize, and store data. Several technological solutions exist that specifically automate the recording of doctor's time and eliminate the risk of violation of Stark Law.
References
This article incorporates public domain material from the Congressional Research Service document "Medicare: Physician Self-Referral (" Stark I and II ")".
External links
- Omnibus Budget Reconciliation Act of 1989 (P.L. 101-239)
- Omnibus Budget Reconciliation Act of 1993 (pp. 103-66)
- Amendment to the Social Security Act of 1994 (P.L. 103-432)
- Why it takes 60 minutes or less to find a strict violation of the law
Source of the article : Wikipedia
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