A NY Criminal Lawyer Explains the Stark Law & Penalties
Physicians should make medical decisions with the best interests of their patients as the only factor in their decision-making. Financial enrichment for the physician or family members should not be an inducement that convinces a doctor to make a patient referral. In order to help ensure that doctors do not make choices when it comes to patient care out of self-interest, the Stark Law was passed to strictly limit doctor referrals.
If you are accused of a Stark Law violation, you face serious financial consequences. The law is a strict liability law, so you may have legal problems even if you were unaware of the fact that the law was violated. You need a New York City defense lawyer with experience in anti-kickback regulations and with knowledge of how best to respond to healthcare fraud cases in order to effectively respond to accusations. Call Bukh Law Firm, PLLC as soon as possible, as our legal team has the background and skills you need to fight back on accusations.
What is the Stark Law?
The Stark Law gets its name from U.S. Congressman Pete Stark, who was the initial sponsor of the bill that resulted in the law being passed. The law is codified in 42 U.S. Code Section 1395nn.
The Stark Law makes clear that, with certain limited exceptions, doctors can’t refer patients for anything (treatment, goods, or services) to a business that the doctor or the doctor’s family members have a financial interest in if the service will be paid for by a government health program.
In addition, companies the doctor has a financial interest in cannot bill government healthcare programs for any patient services if the patient was referred by that doctor.
If an improper referral occurs, entities providing services to patients who were referred by a doctor with a financial interest in the entity may not bill Medicare, Medicaid, or any third parties for the health services performed. If claims for payments are submitted, they can be denied. Any payments which were made for patient services provided after a prohibited referral must also be repaid. These consequences apply regardless of whether the physician or the entity providing patient services was aware of the Stark Law or its referral prohibitions.
Other consequences, including a penalty of $15,000 per service provided and a prohibition from participating in Medicare and Medicaid programs may also be imposed for knowing violations of the Stark Law. If circumvention schemes are used and physicians participate in schemes to refer patients without the referrals becoming apparent, penalties may total $100,000.
What Should You Do If You Are Accused of Stark Act Fraud?
Any physician or entity accused of violating the Stark Law should first determine if their conduct falls within one of the mandatory exceptions to the referral prohibitions in the law. There are a variety of exceptions including:
- A physician services exception, which applies when services are performed by another doctor in the practice of the physician making the referral.
- An in-office ancillary services exception, which can apply in situations where durable medical equipment is provided for patient convenience under certain limited conditions.
- Bona fide employment exceptions, such as when renumeration consistent with the fair market value of services is provided which would be commercially reasonable even if no referrals were made.
These are just a few of the exceptions; determining whether you fit within an exception or not is very complicated and an experienced attorney can help you to carefully review the law.
How Can a NY Healthcare Fraud Defense Lawyer Help?
Bukh Law Firm, PLLC has extensive experience providing representation to clients accused of violating the Stark Law. When you need help with accusations that you made illegal referrals, or when you need any assistance after accusations of health insurance fraud, give us a call so we can get started on developing a legal strategy to protect you.
