Stark and Anti-Kickback Primer

The Private Medical Practice Academy

The Stark Law prohibits physicians from referring patients to entities in which they have a financial interest to prevent financial incentives from driving medical decision-making. The Anti-Kickback Statute prohibits the exchange of anything of value in exchange for referrals for services.
Examples of Stark Law violations:

• A cardiologist refers patients to a diagnostic testing facility in which he has a financial interest.
• A physician is found to be billing Medicare for services provided by an unlicensed midlevel.

Other Exceptions to the Stark Law

• "In-office ancillary services" allows physicians to refer patients for certain designated health services provided in the same building where the physician's medical practice is located if the service is furnished under the direct supervision of the referring physician or another provider in the same group practice and that the arrangement complies with fair market value (FMV).
• Healthcare providers to give non-monetary compensation to physicians and their families up to the annual limit.
• FMV compensation allows providers to enter into financial relationships with other providers if does not take into account the volume or value of referrals.
• Academic medical centers that meet certain criteria may provide compensation to physicians who are engaged in teaching or research activities.
• Rural providers may be able to enter into certain financial relationships that would otherwise be prohibited under the Stark Law provided certain criteria are met.

Safe harbor provisions that provide exceptions to the Anti-Kickback Statute :

• Investments in entities that provide healthcare services if held for one year, and is not be tied to the volume or value of referrals.
• Office space or equipment rented between providers if the rental amount is consistent with FMV and is for a period of at least one year.
• Personal services and management contracts between healthcare providers if the compensation paid is at FMV and not be tied to the volume or value of referrals.

The key takeaways—you can’t do things that are tied to volume or referrals and any financial arrangement has to be at FMV.
I strongly urge you to discuss Stark and AntiKickback with your healthcare attorney so that you know what is required to be in compliance.
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