Category Archives: Stark

March 25, 2021

Directed Referrals: New Stark Rules

By Kim Stanger

Under the federal Stark law, hospitals and other healthcare employers may require that employed or contracted physicians refer items or services to the hospital or another designated provider subject to certain limits. (42 CFR § 411.354(d)(4); see https://www.hollandhart.com/requiring-referrals-from-employees-and-contractors). Effective January 19, 2021, CMS modified the rules for such directed referral requirements in physician agreements. If they have not done so, hospitals and other providers will need to update their physician agreements if they want to require employed or contracted physicians to refer designated health services to the employer. Continue reading →

November 23, 2020

Final Rules for Stark and Anti-Kickback Reforms Issued by CMS and OIG

By Amber Ellis and J. Malcolm DeVoy

On November 20, 2020 the Centers for Medicare & Medicaid Services (CMS) and the Department of Health and Human Services Office of the Inspector General (OIG) issued two final rules to modernize and clarify the Physician Self-Referral regulations (the Stark Law, or Stark) and the Anti-Kickback Statute (AKS) safe harbor regulations. These new final rules generally take effect on January 19, 2021.

The prior Stark and AKS regulations were developed in a volume-based health care delivery and payment system. Over time, and with the rise of data that could be used by providers and payers to better anticipate patient needs and payment for them, concern arose that the existing regulations and policies would potentially inhibit the innovation necessary for moving toward a value-based system of care and payment. These new final rules aim to alleviate those concerns and advance the transition to value-based care and encourage the coordination of care among providers, while continuing to provide important safeguards to protect against fraud, abuse, and overutilization. Continue reading →

September 25, 2020

Paying Employees for Referring Healthcare Business

By Kim Stanger

Many healthcare employers may want to incentivize or compensate their employees for referring patients to or generating business for the employer, but they (appropriately) fear application of the federal Stark law or Anti-Kickback Statute.  The “Paying for Referrals” White Paper analyzes these laws and relevant exceptions that may permit referral-based compensation structures under certain circumstances.

March 11, 2020

Beware Laws Affecting Healthcare Transactions

By Kim Stanger

Republished with permission, this article originally appeared in the online edition of Idaho State Bar’s The Advocate on March 11, 2020.  

Attorneys risk substantial fines, malpractice claims, and even jail time for violating any of several laws implicated in even simple healthcare transactions.  Federal and state healthcare laws potentially affect any financial transaction involving healthcare providers, including employment or service contracts, group compensation structures, investment interests and joint ventures, leases for space or equipment, marketing programs, and patient billing practices.  Failure to comply may result in significant fines and penalties for clients as well as malpractice claims—or worse—against their lawyers.  This article describes several statutes and regulations that can be traps for the unwary in healthcare transactions. Continue reading →