Felt by taxpayers, doctors, and patients alike, the Stark Law has a far-reaching effect on the healthcare system of an entire nation. What exactly does this law do that’s so important? Read on as we cover the basics of this important legislation that actually took form several decades ago.
Legal Purpose, Basic Outline
Let’s start with the intended purpose of this law. Stark Law, also known as self referral regulation, is a set of legislation, or laws, that regulate how doctors refer patients to other medical services. Why is this important?
In times past, when doctors have been allowed to refer patients to any healthcare provider for additional services, this has resulted in some hurtful abuses. Such freedom saw doctors promoting associates, friends, and family for the purpose of kickbacks, or compensation by way of promoting or referring these associates’ services to their patients. Rather than a fair, unbiased, and patient-minded approach, whether patients needed outside services or not, they would be referred to all types of associated services.
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In particular, self referral regulation, or Congressman Pete Stark’s Law, was introduced in order to curb this abuse of the referral system in the elderly and by way of the Medicare insurance system. With such regulation in place, doctors would now be forced to refer services with which they have no personal affiliations when it comes to patients needing extra, external medical care. In the end, this would enforce non-biased and totally health-minded decision-making by the doctor.
Specific Provisions
For those interested in a deeper look at the exact specs of this legislation, The Centers for Medicare and Medicaid Services, or CMS, does a great job of providing a breakdown and explanation of the law.
Per the CMS, there are a total of three, specific tasks that this law seeks to manage:
1. “Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation), unless an exception applies.”
2. “Prohibits the entity from presenting or causing to be presented claims to Medicare (or billing another individual, entity, or third party payer) for those referred services.”
3. “Establishes a number of specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.”
The CMS website also goes on to list all affected DHS as well as a chronological explanation of the legislation.
Penalties and Enforcement
What then happens if a medical professional chooses to violate this protocol? What are the penalties? In short, this depends greatly on the specific encroachment of the law that is thought to have taken place as well as the overseeing branch of justice that will handle the case. Multiple tiers of the American justice system are geared to handle such infractions. The penalties themselves can range anywhere from monetary and civil in nature, to absolute criminal charges.
Fairness and proper motivations are crucial to an efficient and patient-focused medical field. There to enforce this integrity directly is this set of self referral regulations for doctors. To learn more about the Stark Law, https://www.cms.gov/ is an excellent place to get started.
