Stark Law Exceptions that Might Apply to You

Stark Law Exceptions that Might Apply to You

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In today’s video, we discuss some exceptions to Stark Law, which deals with improper referrals by physicians and healthcare practitioners. If you’ve watched some of our previous videos, you’ll know that we already covered a couple of these, like physician services and in-house ancillary services.

But many of our clients have asked us whether there are other categories of exceptions to Stark Law, and what they are.

I’m Michael H. Cohen, founding attorney of the Cohen Healthcare Law Group. We’ve advised over a thousand healthcare industry clients on similar healthcare and FDA legal issues. Today, I’m going to cover some more exceptions to Stark Law governing referrals by physicians and healthcare practitioners. By the time we get through, you’ll know about three more categories of exceptions to Stark that might apply to your healthcare business.

The first category is services furnished by an organization to its enrollees. Physicians can make referrals to organizations that provide a prepaid health service. Examples of prepaid health plans are approved HMOs, approved CMPs, plans approved by the Centers for Medicare & Medicaid Services, as well as other plans identified in Stark Law.  This exception category applies to organizations and entities that contract with the organization.

Another category is for academic medical centers. Physicians who has a financial relationship with an academic medical center can make referrals to that center without running afoul of Stark law if certain conditions are met.  The physicians must be bona fide employees of the medical center, have a valid state license in the state the center is located, be members of the facility’s faculty, and provide clinical teaching services at the center for which they are compensated.  In addition, the center must meet other criteria for approval that are detailed in Stark. If all the above conditions are met, the exception will apply.

A third exception category exists for implants furnished by an Ambulatory Surgery Center. The acceptable implants include cochlear implants, intraocular implants, prosthetic device implants, and others. The implant procedure must be done at the Ambulatory Surgery Center by the referring physician or by one who belongs to the referring physician’s medical group.

As you can tell, each of these exceptions have detailed requirements and conditions that we can’t address in the span of a video. But an experienced healthcare lawyer can give you the full picture on these three as well as on whole other exception categories that we didn’t touch on today.

We know that Stark law is very deep, and the exceptions are very nasty, and that there are exception within exceptions within exception. As well, typically where you have a Stark violation, you also have to contend with the anti-kickback law.

Further, even if you don’t have Federal Stark applying, or the Federal anti-kickback statute, more than likely, you’ll have applicable state law which contains mirrors to the Stark self-referral law on the federal side, on the federal anti-kickback statute.

We look forward to you connecting with us, and we look forward to speaking with you soon.

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