Stark Violations

Houston Stark Law Attorney

Stark Law Compliance & Defense Lawyers in Texas and Across the Nation

If you are contemplating entering an agreement or transaction involving designated healthcare services, it is important to obtain experienced legal counsel who can structure the arrangement in compliance with Stark Law and other state and federal healthcare regulations. The lawyers of Hendershot Cowart P.C. provide knowledgeable legal counsel for healthcare professionals who are contemplating or entering into a transaction governed by the Stark Law.

Our Texas law firm handles healthcare law matters and serves the medical community in Houston and throughout the United States. Call (713) 909-7323 to discuss your specific issue.

What Is Stark Law?

Per Stark Law, also known as the physician self-referral law, physicians may not refer a Medicare or Medicaid patient to another health care entity for designated health services (DHS) with which they or any of their immediate relatives have a financial interest ā€“ defined broadly as any compensation arrangement, or ownership / investment interest.

Penalties for physicians who violate the Stark Law include fines up to $15,000 per billed service from the prohibited referral, and three times the amount of overpayment. Intentional violations could result in further penalties, including provider exclusion.

Does the Stark Law Apply to My Healthcare Organization?

The Stark Law applies to all designated healthcare service providers, including:

  • Clinical laboratory services
  • Physical therapy
  • Occupational therapy
  • Radiology services such as MRI, CT and ultrasound
  • Radiation therapy
  • Durable medical equipment such as wheelchairs, hospital beds, catheters and other equipment
  • Prosthetics and orthotics
  • Home health services
  • Outpatient prescription drugs
  • Hospital services, including outpatient services

If you have questions about whether the Stark Law applies to you, we can help. Our attorneys have more than 100 years of combined experience advising and representing healthcare providers on compliance, Medicaid and Medicare fraud investigations, and other situations in which the Stark Law applies.

What Are the Exceptions to the Stark Law?

Before entering into any designated healthcare transaction that may fall under Stark Law, it is important to determine whether any of the available Stark Law exceptions apply, including:

  • Certain referrals to physicians in the same medical group
  • Certain transactions for in-office ancillary services
  • Certain referrals within prepaid health plans
  • Certain lease agreements
  • Certain personal service agreements
  • Physician employment agreements

Our law firm can advise you whether exceptions may apply to your transaction. We will explain the law, including examining the safe harbors and exemptions that are included in the law. We will help you set up designated healthcare service transactions that comply with Stark. If your healthcare organization is accused of violating the Stark Law, we can advise you and defend you in related administrative proceedings.

How Physicians & Providers Accidentally Violate the Stark Law

Physicians can accidentally violate the Stark Law because of the low degree of intent to commit fraud required for a violation. The Anti-Kickback Statute, for example, takes into account intent to commit fraud by purposefully referring Medicare and Medicaid patients to an affiliated clinic, then avoiding the anti-markup statutes when billing the Centers for Medicare and Medicaid Services (CMS).

The Stark Law, however, does not recognize that a physician may not realize that a financial relationship exists. Under provisions of Stark, if the government can prove that the doctor will benefit financially from the referral for outside diagnostic or lab services, CMS will not be required to pay ā€“ regardless of innocent intent.

Don't Wait to See Whether the OIG Will Investigate

If you realize that you have inadvertently violated provisions of the Stark Law, you may be able to disclose the violation to CMS and negotiate a release from administrative liabilities and claims under Stark Law. If the conduct also includes violations of the Anti-Kickback Statute, however, a settlement with CMS will not resolve those issues (including criminal liability). If compliance with Stark Law or other federal healthcare regulations is a concern, seek the advice of a healthcare attorney with a thorough knowledge of the applicable laws, as well as experience with the self-disclosure protocols for CMS and the U.S. Department of Health and Human Services Office of Inspector General (OIG).

The health law team at Hendershot Cowart P.C. has decades of experience representing physicians and healthcare providers in all areas of Medicare and Medicaid billing and healthcare fraud investigations. Our Houston health law attorneys work with CMS and OIG on your behalf to negotiate the best possible outcome and fight aggressively to avoid criminal penalties stemming from Anti-Kickback Statute, False Claims Act, or Stark Law violations.

Consult with an experienced Stark Law defense attorney at Hendershot Cowart P.C. today.

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