GenInv – Health and Wellness

Often Stark law (physician referral prohibition statute) is mistaken for the federal anti-kickback statute. The difference between the two baffles all. While both laws cover similar ground, an arrangement that’s acceptable under one of these statutes could violate the other. The fact of the matter is that they are different in laws, and different in scope. The Stark statute pertains only to physician referrals under Medicare and Medicaid while the anti-kickback statute is much broader a

nd impacts anyone engaging in business with a federal health care program. The Stark statute doesn’t require bad intent; a tainted financial relationship violates the Stark law irrespective of good intentions. In comparison, the anti-kickback statute requires specific intent and violations may end in criminal actions. The anti-kickback statute is a criminal statute. Originally enacted almost 30 years ago, the statute bars any knowing or willful solicitation or acceptance of any kind of compensa

tion to induce referrals for health services that are reimbursable by the Federal government. For instance, a provider may not routinely waive a patient’s co-payment or deductible. The government would see this as an inducement for the patient to select the provider for reasons other than medical benefit. Whereas these prohibitions were originally limited to services reimbursed by Medicare or Medicaid programs, new legislation increased the statute’s reach to any Federal healthcare program. In

comparison, the Stark law is a civil statute. Enacted initially in 1989, with amendments enacted in 1993 and 1994, the Stark law essentially provides that a doctor may not refer a patient to an entity with which the doctor has an ownership interest or compensation arrangement if payments for the services furnished under the referrals are to be made by the Medicare or Medicaid programs. Contrary to the anti-kickback statute, the Stark Law prohibits referrals for specific designated health services. For more on the Stark law and anti-kickback statute, sign up for an audio conference

.