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The Medical profession is regulated by different rules, which aim to uphold the integrity of the profession. As medical professionals and providers go about their roles in society, it can be hard to keep up with the constantly changing rules. Next to malpractice and negligence, fraud constitutes a majority of the legal cases in the industry. Stark Law is one of the regulations that workers in the healthcare sector have to comply with. This law was established to govern the self-referral practice of physicians regarding Medicaid and Medicare services.
Understanding Stark Law
The Stark Law, published in 1995, was initially structured to prohibit self-referral lab services. It means that a physician could not refer patients who needed lab services to an institution where they had a financial stake. Over the years, the provisions of the law have changed significantly. Now, the prohibitions extend further than just lab services. It is unlawful for medical practitioners to refer services payable by Medicare or Medicaid to entities where, they, or members of their families, have financial interests. Exceptions are provided in the law but rarely do most practitioners or institutions meet them.
The reason for these prohibitions is that physicians and other healthcare professionals may over-utilize some services in a bid to drive more business to their companies. Doing this increases the costs of healthcare, and that means the ordinary citizen and the government have to bear the brunt. There is also the temptation of unethical conduct like misleading diagnoses so that patients can buy drugs from a pharmacy where a doctor has shares. The conflict of interest present in such situations is clear, which is why authorities are very keen on forcing compliance with the law.
Violation of the Stark Law can take many forms from incorrect billing to equipment leasing. The penalties, when caught, can be monumental, both financially and professionally. For each arrangement that is viewed as a violation of the Stark law, payment can be denied. An institution can lose a considerable amount of money because of this. You may also be ordered to refund payment of the services delivered. The authorities can impose a civil fine of $15,000 and a $100,000 for every questionable service. You may also face a false claims lawsuit if a whistleblower is involved. A lawyer with an excellent comprehension of the workings of the Stark Law can provide professional help in case you find yourself in such a pitfall.
Under the statute, it is illegal for medical professionals to solicit funds, take bribes or accept remuneration for the purpose of getting business for Medicaid or Medicare services. The Anti-Kickback statute goes hand in hand with the Stark Law. If found in violation, an individual may end up with a sentence of not more than 5 years in a penitentiary, fines of up to 25,000 dollars, or both. A medical professional convicted of fraud will have a hard time regaining their reputation if it’s even possible. In case of criminal proceedings, licenses and certificates can be revoked, making it another grueling process trying to get them back
The Stark Law and Anti-Kickback Statute are some of the toughest in the healthcare industry. Even the slightest hint of misconduct may trigger an investigation. It is possible to be in violation without even realizing it. Physicians and other medical practitioners have so many relationships; it can be hard to keep up. You may have recommended a service without even thinking twice to learn that you are in violation of these laws. Understanding the actions that may result in prosecution is a top priority for healthcare providers. A Stark anti-kickback lawyer can take lay out the facts of such a case to make it easier for you. Confusion is not your friend when it comes to legal situations, and it certainly won’t do much for your defense.
Healthcare laws can be very complicated what with the shifting legislatures that have to be considered. What may seem like a simple check into your accounts may turn out into a full-blown investigation that may spiral out of control before you know it. Retaining a specialized attorney from the onset can prevent this. A lawyer who understands anti-kickback laws can also help with your business policies. By instituting the right protocols and accountability measures, you can avoid ending up in similar circumstances.