Issue link: http://viewer.e-digitaledition.com/i/90903
StarkReality IF ANY LAW CAN BE CALLED LIVING, THE STARK LAW CAN. SEEMINGLY CHANGING WITH EVERY PIECE OF MEDICAL LEGISLATION, THE PROVISIONS ON SELF-REFERRAL CAN LEAD TO HEFTY PENALTIES FOR PHYSICIAN ORGANIZATIONS THAT DON'T WORK THROUGH THE INS AND OUTS. LET'S START WITH THE BASICS. Self-Referral in Legalese The Stark statutes essentially outlaw Medicare and Medicaid referrals for any service that might fi nancially benefi t the referring organization — mostly. Nearly 20 exceptions complicate this fairly simple definition, leaving many health care providers unsure of when Stark law applies to their referrals. The basic requirements for violation verifi- cation include all of the following: + Re f e r r a ls of Me d i c a r e a nd Medicaid patients + Referrals to fi nancially related entities or immediate family members + Referrals for specifi c health services denoted in the legislation, including ser- vices that fi t into designated categories + Claims for reimbursement for referrals that have been fi led + And, of course, not meet ing any exceptions. Adher ing to Sta rk law is an ongoing process. "It is critical to always keep your relationships with other providers and potential referral sources in mind," says Kevin M. Wood, partner at Texas-based Strasburger Price Oppenheimer Blend Attorneys at Law. "While many arrange- ments can be properly structured, Stark statutes and fraud and abuse consider- ations are always lurking out there, and governmental enforcement activities are increasing in number." Do You Except? Organizations that allow referring physicians or members of the physicians group to provide in-office ancillary services are exempted from Stark viola- tions, largely because the need for these services usually becomes apparent through check-ups. Likewise, Stark grants an exception to services located within the same building to ease patients' experiences, so long as patients do not primarily visit for these services. Wood stresses that providers must be proactive in avoiding Stark law violations. "All too often, a technical violation occurs because a contract terminates but the relationship continues," Wood says. "Most regulatory exceptions require signed, written agreements between the parties, and when they lapse, unknown and inadvertent violations can occur that may still lead to signifi cant penalties. The key is to be proactive in monitoring, instead of reactive." Why Stark? The Stark statutes differ from the anti-kickback law in that they condemn self-referrals regardless of intent. They punish violations because Congress and the Centers for Medicare & Medicaid Services (CMS) consider many of these cases physi- cian abuse. The reasoning: Organizations with access to more services might use more services than are necessary, thus incurring heavy costs for patients. The Stark law exists to preempt that possibility. To contact the CMS for clarification on whether your referral arrangements violate the Stark law, visit cms.gov and search "advisory opinions." s THE COST OF SELF-REFERRAL THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS) has developed a system for organizations to disclose their own noncompliance with the Stark law, essentially opting for quick settlements instead of lengthy — and costly — court proceedings. However, CMS hasn't provided any method for calculating settlement rates, which have ranged from $60 to $579,000. Organizations may be fi ned $15,000 per service for a violation and $100,000 for a business arrangement developed to circumvent the Stark law. 36 | Long Island MD NEWS s MDNEWS.COM