San Francisco, CA , 07/28/2015 /SubmitPressRelease123/
Federal and state laws prohibit health care providers participating in Medicare or Medicaid from having financial interests in businesses or medical practices providing some types of services to their patients. One of the most important of these “Anti-Self-Referral Laws” is the federal Stark law. The purpose of these laws is to discourage excessive use of some services because physicians have a financial relationship with the entities to which they refer patients and thereby stand to profit from ordering the service.
When physicians have financial incentives to refer their patients to certain service providers, it may result in medically unnecessary services or therapies for the patients, unnecessary costs billed to the federal and state government health care programs with physicians reaping increased profits. Under the Stark law, a physician referring patients for certain health care services or ordering supplies or devices paid for by Medicare or Medicaid is prohibited from having investment interests and compensation arrangements with the entities to which patients are referred. This includes,
· MRI and ultrasound imaging centers
· Laboratories
· Equipment sellers, or
· Physical and psycho-therapy clinics.
A doctor or an immediate family member with a financial interest in a business to which the doctor refers patients for care or services paid for by Medicare or Medicaid could be violating the Stark law and other federal or state Anti-Self-Referral laws. Some commonly seen – but still improper financial arrangements that violate the Anti-Self-Referral laws include:
· A physician offers or pays a nominal capital contribution to the third party vendor.
· A physician has been offered or given a better rate of return for little or no financial risk.
· A venture or business partner offers to loan a the doctor the money needed to make the capital contribution to the business.
· A physician was asked to, or the physician has promised or guaranteed to, refer patients or order items or services from the venture.
Improper financial arrangements can take many forms but they usually share one thing in common: the doctor’s referral of a patient for services or ordering of goods with the doctor profiting from these referrals.
Violations of these Anti-Self-Referral laws could also be violations of the federal False Claims Act. In order to get paid by Medicare and Medicaid, providers must certify to the government that they follows all laws covering the provision of healthcare to the program’s beneficiaries, including the Anti-Self Referral laws like Stark. If a healthcare provider billing the government for healthcare services violates the Stark law, they’re making a false claim for payment from the government, which may be a violation of the False Claims Act.
If you’re aware of a physician with an improper financial arrangement between a physician and an entity to which the physician refers Medicare and Medicaid patients for services and you want more information about how to fight health care fraud- and how to develop an optimal whistleblower legal strategy- visit www.ReportGovFraudNow.com.
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