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Texas laws regarding medical practices are complex. Medical professionals are expected to perform their medical duties with a reasonable expectation of care, which is to provide the best possible medical service to their patient. The goal is to keep the patient alive and healthy, or at least to provide comfort when the end is near. The law doesn’t stop there, however. It also requires doctors spend their time staying up-to-date on changing healthcare laws, of which there are thousands. Two of the most prominent laws in Texas are the Stark and Antikickback laws.
What is Stark Law?
No doctor or medical professional is legally permitted to refer patient who use Medicaid or Medicare as their primary insurance to another medical professional for any type of Designated Healthcare Services if the referred location is in any way related to the physician or any member of his or her family’s personal finances. For example, a doctor who sees a patient for an illness and finds that the patient has a disease that requires a specialist, it’s against Texas law for the physician to refer the patient to a specialist who is either family to the physician or owned by the physician in any way.
What is the Antikickback Law?
This is a law with a self-explanatory meaning. It prohibits any doctor from referring a patient to any facility in return for compensation. For example, a doctor cannot refer a patient to the office of another physician because the physician is offering monetary compensation for referrals.
Both of these acts are illegal, but only the Antikickback law is considered a criminal offense. Anyone in a medical facility can violate the Antikickback laws, but only physicians can violate the Stark Law. Both laws come with a certain set of expectations and exceptions, and understating the complex nature of each one is a difficult task for anyone not familiar with the law. An attorney who focuses on the Stark law and Antikickback law is beneficial to all medical facilities, as they can outline the laws, the reasonable expectation, and provide legal counsel when there is any question about a potential referral.
– Is the referral to a physician in the same health or medical group?
– Is the transaction for an in-office ancillary service?
– Is the referral within the confines of a prepaid medical service?
– Is there a lease agreement in question?
– Is there a personal service agreement in place?
Your legal counsel looks to answer each of these questions before allowing you to make a referral to any specific doctor or medical facility to any Medicare or Medicaid patient to help you avoid prosecution.
Breaking the Law
An attorney is necessary when a doctor breaks one of these laws. Violation of the Stark law typically results in probations, fines, and possibly license suspension. Violation of the Antikickback law, on the other hand, could result in criminal charges. This might include fines, restitution, and even time in prison. The counts are reasonable, up to $10,000 in fines and up to 5 years in prison. However, any doctor accused of more than one count of this criminal activity faces these charges for each count.
Attorneys with stark law and antikickback experience work to help their clients avoid criminal penalties, but they do recommend you use their services prior to making any referrals. It’s not always easy to prove a case was a mistake, but accidents do happen. Judges and investigators do understand doctors have a very stressful, highly intense job to do, and focusing on the legal aspects of their job takes away from their reasonable care of each patient. When this occurs, accidents do happen. If we can prove your criminal charge was one you made by mistake, not realizing how it affected you or the law, we can reduce the charges and possibly keep your medical license active.
When accused of breaking either law, don’t respond until you speak to your attorney. Anything you say or do could be used as part of your case, and not always to your defense. Let an attorney with experience help you get through this serious investigation into your referrals.