What does the Stark law mean?
healthcare fraud and abuse law
What is the difference between the Stark Law and the Anti Kickback Statute?
The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.
What is stark and anti kickback law?
§ 1320a-7b.) is a criminal statute that prohibits the exchange (or offer to exchange), of anything of value, in an effort to induce (or reward) the referral of business reimbursable by federal health care programs. …
Is the Anti Kickback Statute civil or criminal?
The Anti-Kickback Statute is a criminal statute, but it provides both criminal and civil penalties for violations. The criminal penalties include fines of up to $25,000 and five years’ imprisonment.
Who does Stark Law apply to?
The Stark statute applies only to physicians who refer Medicare and Medicaid patients for designated health services to entities with which they (or an immediate family member) have a financial relationship. There are almost 20 exceptions to the Stark statute.
Who does Stark law protect?
The Stark law prohibits a physician’s referral for certain designated healthcare services (DHS) to an entity if the physician (or a member of the physician’s immediate family) has a financial relationship with the entity, unless the referral is protected by one or more exceptions provided in the law.
What is an example of the Anti Kickback Statute?
Classic examples of violations of Anti-kickback and Stark laws include: … Drug companies paying kickbacks to insurers to get on their formularies; Payments by specialty pharmacies, DME suppliers, therapy centers, nursing homes, etc. to patient recruiters or to patients directly.
What is a safe harbor under the Anti Kickback Statute?
The safe harbor protects certain arrangements when an individual or entity agrees to refer a patient to another individual or entity for specialty services in return for the party receiving the referral to refer the patient back at a certain time or under certain circumstances.
What is the purpose of the Anti Kickback Statute?
At its heart, it is an anti-corruption statute designed to protect federal health care program beneficiaries from the influence of money on referral decisions and thus is intended to guard against overutilization, increased costs, and poor quality services.
What is an example of a kickback?
The definition of a kickback is slang for a bribe or incentive paid to someone who helped you make money, or a sudden, forceful recoil. When you bid on a job and job is awarded to you and you have to pay someone $1000 because your received the award, this $1000 payment is an example of a kickback.
What does Stark law prohibit?
The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.
Does Anti Kickback Statute apply to private insurance?
Currently, the Anti-Kickback Statute (“Federal AKS”) only applies to Federal health care programs. … The first entity might be for Federal health care business (Medicare and Medicaid) while the second entity might be for private pay health care business (commercial insurance and cash).
How do you prevent anti kickback statute?
Five Tips For Anti-Kickback Compliance
- Be aware of several safe harbors to the federal anti-kickback statute. …
- Implement and follow a compliance program for your practice. …
- Educate yourself about the risks. …
- Ask yourself whether certain gifts are legitimate. …
- Develop standards and procedures to address arrangements with other healthcare providers and suppliers.
What is an illegal provider relationship?
Yes and No. The Stark law prohibits a physician with a financial relationship in an entity from making a referral for designated health services covered by Medicare and Medicaid to that entity even if the services are billed to an individual or other third party payer.