What is a stark letter?
The Stark law prohibits a physician’s referral for certain designated healthcare services (DHS) to an entity if the physician (or a member of the physician’s immediate family) has a financial relationship with the entity, unless the referral is protected by one or more exceptions provided in the law.
What is an example of a Stark law violation?
An example of a Stark law violation is a hospital paying doctors money to refer cardiac patients to their hospital. Similarly, it is a violation of Stark for a laboratory or outpatient clinic to pay hospitals to refer patients to them.
How does the Stark law define fair market value?
With respect to the rental of equipment, fair market value means the value in an arm’s-length transaction of rental property for general commercial purposes (not taking into account its intended use), consistent with the general market value of the subject transaction.
What is the difference between the Stark law and the Anti-Kickback Statute?
The Anti-Kickback Law covers referrals for all services from anyone including physicians or pharmaceutical companies. Conversely, the Stark Law is for referrals from physicians only and covers a set list of “Designated Health Services” (DHS).
Why is it called the Stark Law?
The term Stark Law refers to former U.S. Representative Pete Stark of California, who originally introduced the physician ethics bill in the late 1980s that would later evolve into this law.At that time, healthcare services were provided mostly on a fee-for-service basis, meaning that healthcare providers (HCPs) were …
What is the focus of the Stark Act?
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 does the Stark Law prohibit?
The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.
How do Stark laws protect patients?
What is the focus of Stark law?
What is the Stark law also known as and why is it important to hospitals?
Key takeaways: The Stark Law, also known as the physician self-referral law, prohibits healthcare providers from making referrals to other organizations or medical businesses in which the provider has a financial interest. The law only applies to Medicare patients seeking designated health services.
Does Stark apply to Tricare?
The Stark Law applies to government programs and it does not apply to private insurance. Government programs include programs such as TRICARE, which is the military’s health service. There are two states that have laws that apply to private insurance.
What is the purpose of the Stark Act?
The Stark Law is a public service law that prohibits practitioners from making improper referrals when there is a conflicting financial interest. The law aims to protect the Medicare population from an overprescribing of unnecessary medical services.
What is the final rule on Stark Law?
In addition to adding new Stark Law exceptions, the Final Rule details multiple significant amendments to Stark Law exceptions and concepts, and it further clarifies CMS’s existing policies in order to provide additional flexibility to health care providers and reduced regulatory burden.
What is the decoupling of Stark Law and federal AKS?
Decoupling Stark Law and Federal AKS. One of the primary goals of the Final Rule identified by CMS is to streamline the regulatory language of the Stark Law and to recalibrate the Stark Law exceptions to eliminate multiple references to compliance with the federal AKS and federal and state laws governing billing and claims submission.
What is the exception to the Stark Law for physicians?
Payments by a Physician. CMS finalizes its proposed amendments to the exception for payments by a physician for certain compensation arrangements. Historically, this exception to the Stark Law has excepted payments made by a physician for certain items and services, so long as it was not addressed by another regulatory exception.
What are the changes to the Stark Law for value-based care?
The changes related to value-based care finalized in the Final Rule, including the new Stark Law exception for value-based arrangements, will be addressed in an upcoming K&L Gates Alert. Nearly every exception to the Stark Law requires that compensation paid to a physician be consistent with “fair market value.”