Stark and Anti-Kickback (Part 3): Compliance Tips

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Let me wrap this up with a quick way to spot the issues in this complicated area of law. So what do you do about Stark and Anti-Kickback? Number one, you ask, does the practice involve Medicare patients? If so, you’ve got to worry about the federal side Stark & AKS. If not, then we just worry about the state side.

Number two, on the federal side, is DHS involved? Refer back to the list of DHS we talked about earlier. If no DHS, no Stark analysis. If DHS worry about Stark.

Third, looking under Stark; is the physician referring to an entity where the physician or an immediate family member has a financial relationship, a financial interest?

Fourth, if so, if Stark is a concern, can you find a Stark exception? Look for a bonafide employment arrangement, personal service contract, a lease/rental exception or one of the other exceptions.

Number five, now that you’ve dealt with Stark, is there a prohibited kickback on the federal side? Is anything of value being paid or received in exchange for referral of patients?

Number six, if you’ve got a Kickback, look for any Anti-Kickback safe harbor.

Number seven, now that you’ve dealt with the issues on the federal side, go to the state side and look for potential self-referral, and Anti-Kickback issues, as well as applicable state exceptions and safe harbors.

And number eight, now that you are able to spot the issues, go to your legal counsel and get a written opinion and a preview and analysis. I hope today’s review of Stark and Anti-Kickback issues has been helpful in terms of issue spotting, possible complexities that might arise in a given transaction, compensation arrangement or in your practice.


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