Reviewing Stark Law exceptions

On Behalf of | May 31, 2022 | Medicare and Medicaid Fraud

Healthcare practitioners in Florida have a singular goal of securing the best possible outcomes for their patients. Oftentimes that requires collaborating with other clinicians who specialize in practice areas outside of their own. However, many often look at physician referrals as a potential method of patients unethically profiting from their practices.

Many doctors and surgeons come to the team here at Frank A. Rubino, Esq., P.A. facing accusations of referral malfeasance. Their first questions often center on when their referrals constituted violations. Accusations might come in the wake of any perceived unethical referral. Yet that is not the case.

Excepted referral services

Authorities call the formal statute barring certain referrals “the Stark Law.” This law prohibits doctors from referring Medicare or Medicaid patients to any other individual provider or clinical organization with whom they have a financial relationship. There are, however, excepted services to this law.

According to information shared by the College of American Pathologists, the law exempts referrals made by a physician to another physician within their same practice (or practitioners under the direction of physicians within their same practice) from the Stark Law. The same applies to referrals for services made by the referring physician (or other providers within the physician’s medical group) performed in either the same building the referring physician practices or a centralized building operated by the referring physician’s medical group (and the services performed were not the primary reason the patient contacted the referring physician).

Medical and surgical center exceptions

Particular locations also meet the criteria for Stark Law exceptions. For example, exemptions exist for services performed in an academic medical center for which the referring physician works or shares an affiliation. The same holds true for implants done in an ambulatory surgical center when the ASC furnishes the implant used in a procedure.

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