What is DHS under Stark?
The Stark statute applies only to physicians who refer Medicare and Medicaid patients for specific services (“designated health services,” or DHS) to entities with which they (or an immediate family member) have a “financial relationship.” The lists of designated health services and financial relationships addressed by …
What constitutes a referral under Stark?
Stark broadly defines “referral” to include a request by a physician for an item or service payable under Medicare or Medicaid (including the request by a physician for consultation with another physician and any test or procedure ordered or performed by such other physician), or a request by a physician for the …
Does the Stark law protect whistleblowers?
The Physician Self-Referral Law, commonly known as the Stark Law, and the Anti-Kickback Statutes are two federal laws that protect whistleblowers and prohibit a wide range of conduct by healthcare providers.
Who does Stark law protect?
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.
How can the violation of Stark law be prevented?
Under Stark law, doctors are prevented from making self-referrals. More precisely, physicians are restricted from referring Medicare and Medicaid patients to a DHS (designated health services) provider if that provider has a financial relationship with the physician.
What are violations of the Stark law?
The Stark law prohibits the submission, or causing the submission, of claims in violation of the law’s restrictions on referrals. Penalties for physicians who violate the Stark law include fines as well as exclusion from participation in the Federal health care programs.
Which government agency should a potential stark violation be disclosed?
On September 23, 2010, six months after the enactment of health reform under the PPACA, the Centers for Medicare and Medicaid Services (CMS) published a Voluntary Self-Referral Disclosure Protocol. This protocol allows any physician or provider to disclose actual or potential Stark violations.
How do you comply with Stark Law?
How to Ensure Compliance with Stark Law and Anti-Kickback Policies and Procedures
- Implementing written policies, procedures and standards of conduct.
- Designating a compliance officer and compliance committee.
- Conducting effective training and education.
- Developing effective lines of communication.
How does the Stark law impact physicians quizlet?
How does the Stark Law impact physicians? The Stark Law prohibits a physician from referring a patient for certain “designated health services” to an entity with which the physician has a “financial relationship.” In addition, a provider may not bill Medicare for a claim based upon a prohibited referral.
In what situation is a written agreement not required under Stark?
Many stark exceptions require a written agreement between a referring physician and an institution with which he maintains a financial relationship.
Are safe harbors voluntary?
SAFE HARBORS GENERALLY Compliance with safe harbors is voluntary, and arrangements that do not comply with a safe harbor must be analyzed on a case-by-case basis for compliance with the anti-kickback statute.
Which of the following is prohibited by the Anti-Kickback Statute quizlet?
What does the Anti-Kickback Statute Prevent? Prohibits offering, paying, soliciting, or receiving anything of value in induce or reward referrals or generate Federal health care program business. What is the OIG? Office of Inspector General.
What is fair market value under Stark Law?
Fair market value for rental of equipment is defined as “the value in an arms-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.”
Which of the following is prohibited by Anti-Kickback Statute?
The Anti-Kickback Statute and Stark Law prohibit medical providers from paying or receiving kickbacks, remuneration, or anything of value in exchange for referrals of patients who will receive treatment paid for by government healthcare programs such as Medicare and Medicaid, and from entering into certain kinds of …