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Jan 8, 2015 by |

Sticky Situation For Doctors And The Stark Law

The Stark Law prevents doctors from receiving kickbacks by referring Medicare and Medicaid patients for designated health services (DHS.) Referrals for DHS include physical therapy, occupational therapy, radiology, computerized axial tomography scans, ultrasounds, radiation services, and such. This law however, contains exceptions. Doctors may refer patients for physician services and supplementary in-office services, and can also refer patients to organizations that they have a financial interest in, if they are publicly traded companies or mutual funds. In March 2010, the exception for supplementary services was updated to state that when doctors make referrals to Medicare and Medicaid patients in-office, they must also provide written notice that Medicare and Medicaid patients may seek the services elsewhere and they must provide a list of alternatives. This way Medicare and Medicaid patients have a choice and it further prevents doctors from receiving kickbacks through Medicare fraud.
If in any case, violation of the Stark Law and Medicare fraud is proven, doctors may face penalties including:
• Payment for the provision of DHS may be denied.
• Doctors or the organizations that received money for the referral of services that violate the Stark Law may have to pay back the money they received for the services.
• For each service that constitutes Medicare fraud or violation of the Stark Law, a doctor or organization that knowingly provides the service is subject to civil penalties as much as $15,000, plus three times the payment they received from Medicare for the service.
• Doctors may also be face exclusion from Medicare and Medicaid and/or other state health care programs.
• If ongoing Medicare fraud or violation of the Stark Law is uncovered, doctors may be fined as much as $100,000 for each systematic Medicare fraud that they have carried out to get around compliance with the law and for which they have received significant kickbacks.

The other side of the argument is that doctors who have a financial interest in referral services have not participated fraudulently in Medicare and Medicaid programs, but rather have simply provided a service where there was a high demand for the referrals with a low supply in the market.

If you believe that you or someone you know has information about Medicare fraud or violation of the Stark Law, you may contact the Evans Law Firm, Inc. for a free and confidential consultation at 415-441-8669 or The Evans Law Firm, Inc. takes cases involving physical and financial elder abuse, personal injury, banking/insurance fraud, consumer class action fraud, and qui tam (whistleblower/false claims) litigation.

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