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Stark Law: Self-Interferral Process

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Stark Law: Self-Interferral Process
Stark law is the set of United States federal law that prohibits healthcare providers from engaging in a self-referral of the patient for various health related service, when the health care provider or any other immediate family member of provider has any kind of financial relationship with the entity. This law also prohibits the health care provider from referring (self-referral) the patient to other entities for designated health service (DHS) payable by Medicare and Medicaid when there is any kind of association between provider and entity (Vendenack, 2011). Similarly, this law also prohibits the healthcare organization from billing Medicare of any other health related service provided as a result of self-referral process. This kind of …show more content…
In 1992 stark Law I, was passed by the congress after they put the provision in the Omnibus Budget Reconciliation Act of 1989 (OBRA 1989) that band self-referral for laboratory service charge. Stark law I talk about the exception of ban for different legitimate health care service needed for the treatment process. Later, on 1994 stake law II was named by providing the clarification, modification and technical correction to the original Stark Law I. After serious of questions and concerns about this law from health care provider, on 1995 congress gave a final approval regarding the amendment to physician self-referral provision. This made federal register to announce the Stark law III which contain all the prohibition base compensation arrangement and reduce in the list of ban on the health care service. This law become effective from 2007 (Vendenack, …show more content…
Factors The Anti-Kickback Statue The stark Law
US Code (42 USC § 1320a-7b(b)) (42 USC § 1395nn)
Prohibition Prohibit any kind of offer related to finance or non-finance that induce the federal health care program (Oig.hhs.gov, nd) Apply only to the healthcare provider who refers Medicare and Medicaid patient to the entity with whom they are financially related (Mangan, 2003).
Intent Require specific intent No specific intent necessary
Boundaries No boundaries for permissible behavior but should not violate the law. It defines the boundaries of permissible behavior.
Patient Referral Anyone can refer for any kind of healthcare service Only referrals form a physician for designated health service Penalties Exclusion from federal health care programs
$25,000 per violation and up to 5-year prison per violation (Oig.hhs.gov, nd) Civil Money penalties

$15,000 CMP for each service
Punishment False claims acts liabilities, civil monetary penalties, potential $50,000 CMP per service, civil assessment up to three times of amount (Oig.hhs.gov, nd) False claim act, overpayment/ refund obligation, $15,000 CMP for service and up to three times of civil assessment per claim (Oig.hhs.gov,
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