Who Does The Stark Law Protect?

Does Stark law protect whistleblowers?

Stark law violations are a major source of qui tam cases filed by whistleblowers under the False Claims Act.

As they exist today, the Stark Law prohibits physicians from receiving a financial benefit for ordering, referring, or performing certain types of Designated Health Services (“DHS”)..

What is an illegal kickback?

A kickback is an illegal payment intended as compensation for preferential treatment or any other type of improper services received. The kickback may be money, a gift, credit, or anything of value.

Which of the following is an example of a Stark law violation?

Entering into contracts with 19 specialist physicians that required the physicians to refer their outpatient procedures to Tuomey in exchange for bribes. Ignoring and suppressing warnings from attorneys that the physician contracts were “risky” and raised “red flags” Filing more than 21,000 false claims with Medicare.

Who does Stark Law apply to?

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 does the Stark law prevent?

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.

What is Stark II law?

Stark II prohibits a physician or immediate family member who has a direct or indirect financial relationship with an entity from making referrals to that entity to provide designated health services (DHS) payable by Medicare or Medicaid, unless an exception applies.

What is an example of the Anti Kickback Statute?

The Anti-Kickback Statute The illegal kickbacks can be cash payments, but often include other items of monetary value, such as gifts, free or discounted supplies or services, and travel. … For example, they might pay doctors inflated rates for speaking engagements or pay above fair market value to lease office space.

Do Stark laws apply to employed physicians?

Both the Stark Law and the Anti-Kickback Statute contemplate employment of physicians by hospitals, and accordingly, both include an exception to accommodate the compensation paid by a hospital employer to a physician employee.

What is the difference between Stark and Anti Kickback?

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.

What is an illegal provider relationship?

The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.

What is the purpose of Stark law?

The Stark Law is a healthcare fraud and abuse law that prohibits physicians from referring patients for certain designated health services paid for by Medicare to any entity in which they have a “financial relationship.” The federal government interprets the term “financial relationship” broadly to include any direct …

What is a safe harbor under the Stark Act?

The safe harbor regulations define payment and business practices that will not be considered kickbacks, bribes, or rebates that unlawfully induce payment by Medicare or Medicaid programs. The regulations specify allowable financial and referral relationships between physicians or other providers and suppliers.

Who does the Anti Kickback Statute protect?

The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …

What is Qui Tam law?

Definition. In a qui tam action, a private party called a relator brings an action on the government’s behalf. … For example, the federal False Claims Act authorizes qui tam actions against parties who have defrauded the federal government.

What makes it illegal to bill for services that are not necessary?

Answer: Medicare regulations set standards for quality of care and make it illegal to bill for services that are not necessary.