STARK: When can physicians refer patients to their group practice?

Physicians who self-refer could be in violation of federal law and fraud against the government.

The Stark Laws are related to, but different from the federal Anti-Kickback law (42 U.S.C. § 1395nn).  Physician self-referral is a term used to describe when a physician refers a patient to a medical facility in which she or he has some sort of financial interest.

The Stark Laws were created in response to upward costs in healthcare associated with over-utilization of services. However, this does not require every service to be referred out by a physician.

One exception that comes in to play frequently is the In-Office Ancillary Services Exception. This exception allows physician group practices to own and receive compensation for imaging services and other designated health services within her or his group.

In 2010, legislation required an internal referral from a physician group for a MRI, CT, or PET scan to provide the patient at the time of referral with a written notice that the patient may seek the service from somewhere outside of the group practice and must have a list of other suppliers in the area.

If you have uncovered a self-referral scheme, contact the whistleblower lawyers at Miller Law Group for a free consultation.

Additional Resources:

Whistleblowers and The False Claims Act – Frequently Asked Questions

What is medical bill upcoding and why should I worry about it?

Whistleblower Helps Recover $11.85 Million in Medicare Kickback Case