What is the Stark Law and how can it impact Texas physicians?
Texas physicians and other medical professionals will strive to provide the best possible care for their patients and give them the services they need. If medical care were as simple as that, it might be much easier to navigate. However, the reality is that health care, billing and adhering to the various regulations to avoid allegations of wrongdoing can be complicated. There are areas of fraud and abuse that the federal and state governments look for. Failure to follow the law can result in criminal charges, problems with the Texas Medical Board and place an entire practice in jeopardy. One law that should be understood from the outset of a practice is the Physician Self-Referral Law. This is called the Stark law for short.
Understanding the Stark law
Since federal health insurance coverage like Medicare and Medicaid is so rife for overcharging and abuse, the government is attentive to potential red flags. The Stark law makes it illegal for physicians to refer a patient to have health services that will be paid for by these entities if the provider is the physician or a family member will financially benefit from it. There are exceptions to this rule. The term “designated health services” is key. This means clinical lab services; therapy; imaging and radiology; radiation therapy and more.
The Stark law has certain intentions and penalties. The intent is to penalize physicians if they knowingly committed a violation. There are times when there might have been a referral that appeared to violate the law, but was in fact valid and the facility to which the referral was made simply happens to be linked to the physician. The penalties can include refunds, being liable under the False Claims Act, needing to pay financial penalties, being excluded from Medicare and Medicaid and hefty fines.
Fighting accusations of Stark law violations requires experienced help
Knowing how to comply with the law is imperative. It is also crucial to know what to do when there are accusations of violating the Stark Law. There is a perception that physicians are well-off and once they have a practice established in the community, they have little to worry about. Unfortunately, that is untrue. Accusations of wrongdoing can damage a practice and lead to a litany of personal, financial and professional problems. For new practices and people who have just started their professional careers, getting accused of violating the Stark law will cast a negative pall over their work. To fight these allegations of health care law violations, it is important to have experienced, skilled and knowledgeable help in a relatively underserved area of the law. Having a zealous defense can suit a physician’s interests and deal with the case as effectively as possible.