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The Stark Law

There are numerous federal statutes that dictate what constitutes unethical and unlawful behavior for physicians and other health care professionals. One of those statutes, 42 U.S. Code §1395nn, is known as the Stark Law. It prohibits physicians from having inappropriate referral and financial relationships with facilities in relation to Medicare and Medicaid patients. When Medicare or Medicaid is billed for patient services that arise from an illegal referral or financial relationship, then these claims are automatically considered fraudulent. Physicians and health care professionals can face civil claims for violating the Stark Law.

If you have information regarding an unethical referral system between a physician and health care facility, and you believe it leads to fraudulent claims to Medicare, contact a San Francisco Stark Law lawyer right away. Your information may give you the right to file a qui tam claim under the federal False Claims Act, which if successful, gives you the opportunity to share in the government’s financial recovery.

The Stark Law

The federal Stark Law specifically prohibits physicians from referring Medicare patients for certain health care services to an entity with which the physician, or one of his or her immediate family members, has a financial relationship. In other words, physicians cannot refer Medicare patients to a facility in order to increase that facility’s profit, which in turn increases the physician’s (or their relative’s) profit. The financial interest may be an ownership stake, investment in the entity, or a structured compensation arrangement with the entity.

The Stark Law creates liability under the federal False Claims Act. This means federal authorities can file a civil claim against physicians for violating the Stark Law. Also, private individuals can file suit on behalf of the government through an FCA qui tam claim.

Through an FCA claim, the physicians can be penalized up to $15,000 for each referred service and a penalty up to three times the amount claimed from Medicare. The participating physician or entity can also be excluded from working with federal health care programs for knowingly violating the Stark Law.

To learn more about the Stark Law or FCA violations, contact a Stark Law lawyer in San Francisco.

Differences Between the Anti-Kickback Statute and Stark Law

It is important to note that the Stark Law is not as broad as the Anti-Kickback Statute, which prohibits health care professionals from offering, paying, soliciting, or receiving payments or anything else of value for referrals or other health care businesses that impacts a federal health care program, like Medicare or Medicaid. The Stark Law applies only to referrals from physicians while the anti-kickback statute covers referrals from anyone. While the anti-kickback statute covers any health care items and services, the Stark Law covers only designated health care services.

Another significant difference between the two is in regard to intent. For someone to be found guilty of the anti-kickback statute, he or she must have had intent. The violation of the law must have been knowing and willful. This is not the case with the Stark Law. Physicians and health care entities are strictly liable for maintain above-the-board referral and financial relationships. However, certain financial penalties are only assessed in civil claims for knowing violations of the law.

To further discuss the differences between the anti-kickback statute and the Stark Law, and whether you are aware of a violation of one or both laws, call a San Francisco Stark Law attorney at Willoughby Brod, LLP.

Exceptions to the Stark Law

There are close to 20 mandatory exceptions that enable lawful referral relationships between physicians and other health care entities. These exceptions include physician referrals within a group practice, referrals for in-office ancillary services, and referrals within prepaid health plans. Other types of exceptions include when the financial relationship includes renting office space or equipment, bona fide employment relationships, personal service agreements, and physician recruitment.

If you believe a physician is violating the Stark Law, yet you are not sure if the conduct is part of an exception, you should speak with an attorney at Willoughby Brod, LLP. We have years of experience handling FCA claims, including those related to the anti-kickback statute and Stark Law. We are well-versed in the exceptions and what constitutes lawful referral conduct by a physician. Call us now or use our online form to schedule an appointment to speak with one of our Stark Law attorneys in San Francisco.

You may Have a Qui Tam Claim

If you determine, after speaking with an attorney, that it appears a physician is violating the Stark Law and does not fit into one of the many exceptions, then you may be able to file a qui tam claim. A qui tam suit under the FCA is one that you file, as a private citizen, on behalf of yourself and the federal government. The U.S. is notified of the suit, given the opportunity to investigate, and has the right to intervene. Whether or not the government joins the suit, you may pursue compensation for the physician’s unlawful conduct. If the government joins and obtains a settlement or court award, then as the person who filed the qui tam suit, you will receive a portion of the financial recovery.

Call Willoughby Brod, LLP today to discuss filing a qui tam case based on a violation of the Stark Law.

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