Stark Law Defense.

Stark Law contains a set of U.S. federal laws, with a focus on healthcare abuse and fraud. The law prohibits doctors from referring patients to a specific health care provider that is paid for by Medicare if they have a financial arrangement or will otherwise benefit financially. Given the potential broad interpretation of a financial arrangement, the government has actually defined it as the referring physician having either a direct or indirect investment interest or ownership. This interpretation includes any of the physician's family members.

Since Stark Law isn't a criminal statute, there are several agencies that can pursue civil action if it's violated. This is something that is generally pursued by Health and Human Services through the Inspector General and can result in thousands of dollars in monetary penalties for each one of the services billed to Medicare. There are other penalties associated with this violation that could potentially triple the penalty.

What is Stark Law?

Stark Law contains a set of U.S. federal laws, with a focus on healthcare abuse and fraud. The law prohibits doctors from referring patients to a specific health care provider that is paid for by Medicare if they have a financial arrangement or will otherwise benefit financially. Given the potential broad interpretation of a financial arrangement, the government has actually defined it as the referring physician having either a direct or indirect investment interest or ownership. This interpretation includes any of the physician's family members.

What Constitutes a "Financial Arrangement"?

Who Enforces Stark Law?

When a claim is brought against a physician for violating Stark Law, the practitioner's attorney will generally have to defend them against Medicare, Medicaid, the Inspector General, and the Department of Justice. The charge is that the physician violated Stark Law, when intentional or unintentional.

Since Stark Law isn't a criminal statute, there are several agencies that can pursue civil action if it's violated. This is something that is generally pursued by Health and Human Services through the Inspector General and can result in thousands of dollars in monetary penalties for each one of the services billed to Medicare. There are other penalties associated with this violation that could potentially triple the penalty.

Agencies That Enforce Stark Law

Strict Liability: Intent Doesn't Matter

What's tricky about Stark Law is that there is no requirement to prove that the physician intended to violate the law. This is because it's a strict liability statute. In other words, a physician that made prohibited referrals and did so accidentally, can be found responsible for breaking the law. This means a physician can unknowingly break Stark Law and be subject to steep penalties. It's worth noting that practitioners who violate the law with intent are subject to greater penalties.

Understanding Strict Liability in Stark Law

CRITICAL: A physician can unknowingly break Stark Law and be subject to steep penalties. This is because it's a strict liability statute - the government does NOT have to prove intent.

Stark Law Exceptions