Stark Law and HS Fraud Defense Attorneys
Stark Law Violations Such As Improper Billing For Designated Health Services Are Federal Offenses That Can Result in Criminal Prosecutions and Civil Actions. We Defend Physicians And Other Healthcare Professionals Nationwide Against Accusations of Improper Billing.
The Stark Law is a term for a series of federal laws that control financial dealings between healthcare providers and other businesses and persons. The Stark Law generally applies to the prohibited “self-referrals” for the health services it specifically designates.
It’s safe to say that most healthcare providers have heard of the Stark Law and are generally aware of it. However, considering its complexity, very few of them really understand it. Most physicians don’t understand what exactly the Stark Law prohibits and how it affects multiple business transactions and relationships.
Because the Stark Law is really a very complex labyrinth of rules, it is rather easy to violate it, which is exactly what happens across the country with the federal government’s relentless crackdown of the Stark Law violations. Most providers are often surprised to find themselves being accused of fraud pertaining to designated health services billings and self- referrals.
Besides potentially facing criminal charges, Stark Law violations can trigger civil litigation and overpayment claims under the False Claims Act and other federal statutes. Having an experienced attorney or legal team with a solid understanding of this complicated area is essential to any physician or healthcare provider. At Norman Spencer Law Group, we have represented hundreds of healthcare providers. Our firm is the only answer you need when you are facing allegations of designated health services fraud.
What is the Stark Law’s Prohibition on Self-Referrals for Designated Health Services
In order to successfully defend against allegations of designated health services fraud under the Stark Law, physicians and businesses first need to understand whether (and to what extent) any consummated transactions may have violated the statute. This requires a clear understanding of the definition of both a “self-referral” and a “designated health service”.
What is a Self-Referral?
The Stark Law, banning self-referral, defines self-referral as any dealing or a transaction between a physician and the second party where payments are involved in relation to Medicaid or Medicare patients.
The Stark law generally bans a healthcare provider from making referrals for health services paid for by Medicare to any entity with which the provider or his or her immediate family members have a financial relationship. An example of such a relationship is full or partial ownership, investment, or compensation. The law also prohibits submitting bills to Medicare for those referred services.
What Are Examples of Designated Health Services
These are the examples of the designated health services within the meaning of the Stark Law.
- Clinical laboratory work
- Physical therapy
- Occupational therapy
- Outpatient speech-language pathology
- Radiology and other imaging services
- Radiation therapy and supplies
- Durable medical equipment and supplies
- Parenteral and enteral nutrients, equipment, and supplies
- Prosthetics, orthotics, and prosthetic devices and supplies
- Home health services
- Outpatient prescription drugs
- Inpatient and outpatient hospital services
Are There Exceptions to the Stark Law Prohibitions?
As is often the case with complex legislation, the Stark Law does contain numerous exceptions. For practical purposes, if the physician can demonstrate that the payment or the transaction in question is included in the exception list, there is no problem with the self-referral violation and no one is liable. Here are some of the exceptions of the self-referral prohibition under the Stark Law:
- Office space lease payments
- Equipment rentals payments
- Salaries for legitimate employment
- Compensation for legitimate personal services
- Bona Fide recruiting incentives received by the physician at hiring
- Certain transactions in which payments are made in accordance with fair market value, which does not depend on the volume or value of any referrals
- Non-monetary reimbursements and compensations that are lower than the threshold set by the law
- Incidental benefits to hospital staff
Oftentimes, it is not obviously clear whether the exception applies to a particular payment or transaction. The government is aggressively pursuing any allegations of the Stark Law violations, and in situations where there is an appearance of a violation, the physician or entity will face a federal investigation.
An experienced healthcare fraud defense attorney should be able to effectively defend the client against such investigations, which is what we do at Norman Spencer Law Group. With years of experience and a solid understanding of the law, we have helped numerous physicians and healthcare entities by convincing the government that their cases fell under the Stark Law exceptions.
Many cases involving the allegations of designated health services fraud are brought under the Stark Law, however, health care providers can also be prosecuted under other statutes such as the False Claims Act, as well as regular criminal statutes like Mail and Wire Fraud, Healthcare Fraud, and Conspiracy. Here are the practices that commonly lead to such prosecutions, which we encounter in our practice:
- Billing Medicare or Medicaid for Self-Referrals– Submitting claims to a federal health program such as Medicare or Medicaid for funds used to pay self-referrals is one of the examples of designated health services fraud, leading to civil and criminal liability for all parties involved.
- Inappropriately Categorizing Designated Health Services– Health care providers can be liable for inappropriately classifying designated health services as non-designated services so that they can circumvent the Stark Law’s prohibitions.
- Billing for Medically Unnecessary Designated Health Services– This is one of the most seen practices that can lead to an investigation and liability. Submitting bills to Medicare or Medicaid for medically unnecessary services is a violation of the Stark Law and other federal statutes. Establishing that the services were medically necessary may be a daunting task requiring the heavy use of medical experts.
- Overbilling– Overbilling for designated health services is the same as falsely classifying health services and billing for medically unnecessary services.
- Billing and Coding Violations – There are a number of coding violations that physicians may be committing, knowingly or unknowingly. All of these may result in criminal prosecution for Medicare or Medicaid fraud, regardless of whether these violations fall under the self-referral prohibition provisions of the Stark Law. Billings for designated health services under the Stark Law are no different than billing for any other healthcare services and are subject to the same rules and regulations.
FAQs: Designated Health Services Fraud Defense
Is My Practice In Violation of Stark Law?
As you can see from the text above, Stark Law regulations may be quite complex. In order to determine whether a client is in violation, we begin with an internal compliance assessment of the client’s practice. It is important to conduct this assessment before any documentation is turned over to the authorities. That would allow us not only to understand the potential liability but also be prepared in advance, as we will work to find the best solution. Another great benefit to turn over the documentation to your attorney before the government is to ensure that it is protected by the attorney-client privilege.
What Are the Potential Penalties For the Stark Law Violations?
Under the Stark Law, the list of potential penalties includes monetary claims, fines, and other financial penalties as well as (in criminal cases) criminal fines and imprisonment. It is also very likely to result in exclusion from Medicaid and Medicare.
When Do I Need To Retain Norman Spencer Law Group?
You need to engage an experienced healthcare defense attorney as soon as you find out that you are under investigation, however that happens. Never speak to investigators and never turn over any documents to them before you call us. The sooner in the process, you call our office, the better your chances of a successful outcome.
How Norman Spencer Law Group Can Help Protect You
We are a great choice for any healthcare professional facing the federal government because we are efficient, competent, and dedicated to each client. We do not make empty promises and unrealistic claims to get business. When you are our client, you will rely on the well-prepared and organized legal team ready to go any length to get you where you need to be.
If you are a physician or a healthcare provider facing allegations of healthcare fraud or any other federal investigation, call us today, no matter where you are in the country and speak to an attorney to receive an evaluation of your case.