Possible consequences of violations of physician selfreferral rules include

Can a physician be guilty of violating the AK? What are the penalties for violating Stark Law? PHYSICIAN SELF-REFERRAL OR STARK LAW Violations The Stark law generally prohibits physicians from referring patients for Designated Health Services to facilities in which the physician or an immediate family member has a financial interest.

A “ referral” can include ordering or certifying the need for a designated health service. The Stark law is a strict liability statute, which means proof of specific intent to violate the law is not required. Sanctions for violations of the Stark law include the following: Denial of payment – Medicare is prohibited from paying for DHS furnished pursuant to a prohibited referral.

Penalties and violations. The Stark law prohibits physicians from referring patients for certain services payable by Medicare to entities in which they or their immediate family members have financial interests, unless a statutory or regulatory. The SRDP sets forth a process to enable providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute. If a physician makes a referral that is prohibited by the law and no exception applies, the Stark law’s prohibitions and penalties can be imposed.

Among the frustrating realities for physicians , administrators, and others in the medical profession are never-ending compliance obligations. Regulations can be complex and dense, with compliance costly and time-consuming. The so-called “STARK” framework is frequently overlooked. But it is complex, expansive, and unforgiving, and the potential consequences for non-compliance are severe and.

Last, physicians and entities may be excluded from participating in the Medicare and Medicaid programs.

Given the complexity of relationships between healthcare providers, violations of the Stark Law are unfortunately common and inadvertent. The self-referral disclosure protocol may be an efficient way to report known violations. However, a Medicare provider should consider several factors before using the SRDP or it may possibly face unintended consequences. For example, Arizona’s self-referral law applies only to medical doctors and surgeons, while California’s Stark laws include all healing arts.

Another common distinction is the type of service or activity contemplated. For example, Montana’s self-referral law specifically prohibits medical practitioners from owning pharmacies, but Montana law does not, for example, prohibit physicians to. The Financial Analysis Worksheet replaces a more general requirement to provide a “financial analysis relating to the actual or potential violation (s) of the physician self-referral law. Under the new procedure, a disclosing party must provide prepare an analysis worksheet in Excel-compatible format.

For each physician included in the disclosure, the worksheet must include all of the. This smacks of a kickback. In fact, Stark violations are similar to kickbacks (which are similarly illegal and unethical) because they have a tendency to influence the doctors’ decision to.

Physician Relationships With Payers 10. Obamacare has added new layers that increase the burden on doctors to ensure they are in compliance with the Stark law and its regulations. Additionally, other statutes, including the Anti-Kickback Statute and the Health Insurance Portability and Accountability Act. These forms are part of a self-referral disclosure protocol (SRDP) that establishes a process for health care providers to voluntarily report physician self-referral violations.

The proposed regulations are designed to address any undue regulatory impact of the physician self-referral law and adopt new exceptions to bolster the ability of physicians to engage in VBAs. The primary focus of the proposed regulations is the concern that because the consequences of noncompliance with the physician self-referral law are so dire, providers, suppliers, and physicians may be. The CMS Proposed Rule aims “to alleviate the undue impact of the physician self-referral statute and regulations on parties that participate in alternative payment models and other novel financial arrangements and to facilitate care coordination among such parties” with new exceptions for value-based compensation arrangements between or among physicians , providers, and suppliers that.

A self-referral involves referring a patient for “designated health services” to an entity that the referring physician owns (wholly or in part) or with which the referring physician has a financial relationship. An illegal kickback involves remuneration paid in exchange for any referral for patient services, equipment, or supplies for which payment is made under a federal healthcare. Potential violations include : Services Not Rendered: Billing for services that were not performed on a patient is a violation of the False Claims Act.

Ghost Patients: Submitting claims for services, tests or medical devices to a patient who does not exist or who the provider has no physician -patient relationship with is a violation of the False Claims Act.