Stark Law Lawyers
The healthcare industry is a huge machine that generates millions of dollars each year. An industry of this size opens the door to an increasing number of fraudulent claims submitted to federal programs such as Medicare, as well as state and local healthcare programs.
For this reason, over the years our government has implemented many different laws, rules, and regulations. So many in fact, that they often overlap and/or contradict one another. Added to this, we also have state and local laws to decipher. Of all these laws, one of the most complicated and often challenged is the Stark Law. This law is not only complicated but is seldom fully understood by anyone who has not specifically studied healthcare laws.
What is Stark Law
Most people have probably never heard of the Stark Law while others may have only a vague idea of the law. Even fewer people understand the details, the nuances to be inferred, or the exceptions to the law. The latter, the exceptions, is often the vital difference in the determination of the legality of a business and some, or all of its practices. Generally speaking, making referrals by a physician to any person or company that provides healthcare services involving Medicare is proscribed.
If a physician, or any immediate family member, has a financial interest or financial arrangement with any healthcare provider, it is illegal to make patient referrals to that provider. These would include, as an example, a laboratory, specialist, or any other healthcare provider. This seems simple enough but many try to find ways to get around Stark Law by seeking the protection of the exceptions.
Stark Law & Health Care Fraud Attorneys
Stark Law Lawyer specialize in healthcare law. The Stark Law is one of the most controversial areas of healthcare rules and regulations. Only trained Stark Law defense attorneys have the expertise and knowledge to work through this maze alongside the client. When an exception can be shown to be legitimate, according to the regulations, a Stark Law attorney will find it and fight for the rights of the client.
If charged with accusations of having made any Designated Health Service (DHS) referrals to a laboratory, for instance, in which the physician has a financial interest, the legal implications can be disastrous. Without the specialized training of a Stark Law defense attorney, whether a claim is legitimate or not, the accused is almost certain to be sentenced to fines, reimbursement of any funds received through Medicare billing, and can serve prison time as punishment.
In a matter of only days, a career can be ruined for life. Stark Law defense attorneys understand every aspect of Stark Law and are in a position to prevail despite an aggressive prosecution. Most lawyers specialize in one field such as bankruptcy, criminal law, etc. While an attorney may be highly competent in their field of expertise, few attorneys are prepared to mount a proper defense for a client who has been charged with fraudulent behavior.
DHS or Designated Health Services follows what is known as the Current Procedural Terminology (CPT). This code, in combination with other laws, defines Health Services in a litany of categories. These may be found listed at the end of this article.
Stark Law defines a financial relationship as any financial connection, direct or indirect, whereby a physician or other healthcare provider has an interest in an entity and engages in a compensation arrangement between the entity and healthcare provider or immediate family member. Even lacking that, when a physician makes a referral and the DHS provider provides remuneration, the Stark Law may define that as fraudulent, even though there has been no prior financial arrangement.
Stark Law Goes Beyond Medicare
Any agreement between a physician and any other entity in the healthcare field may still be labeled as federal, and may, therefore, be subject to Stark Law. With the confusion and complication of some of the wording in Stark Law, a Stark Law defense attorney’s understanding of the nuances of this law is vital. It takes every bit of this understanding of the law to defend against any charges made by the courts.
Even when Medicare invoices have been submitted by hospitals on behalf of physicians, the physicians may still be charged by the federal government. They may use the False Claims Act to bolster their charges. If a joint venture goes beyond selling or consignment of merchandise, the courts may extend the time needed to completely review the case on an individual basis. That, however, does not necessarily exculpate those submitting claims to healthcare services.
One of the primary restrictions imposed by the Stark Law is indirect compensation. This restriction must be satisfied before any Medicare payment will be made. To satisfy the Stark Law exception for indirect compensation arrangements the following must be met:
- The compensation must be fair market value without any inflated prices or payments.
- It must be shown that the compensation agreement has been clearly detailed in writing, stating what the arrangement is, and it must be signed and dated by both parties.
- The arrangement must be legal, i.e. it cannot violate the Anti-Kickback statute or any other laws or regulations whether federal, state, or local.
Contact The Healthcare Fraud Group & Get Answers
Our Stark Law attorneys have been retained for years by clients throughout the United States because of their experience and their complete understanding of every nuance of Stark Law including its strengths and its weaknesses.
Stark Law attorneys at the Healthcare Fraud Group have the specialized knowledge to defend clients against formidable opponents such as the Office of Inspector General, the Department of Labor, the Department of Health and Human Services, the Department of Defense, and the Department of Justice. All of these specialized departments have but one interest as a goal: to ensure that all the laws and regulations are met and followed accurately. When one of these entities launches an investigation into the financial practices of a healthcare professional, it’s time to call a competent Stark Law defense lawyer. The investigation will be aggressive and thorough.
If charged with medical fraud, few people are able to defend themselves. Without the knowledge and advice of a Stark Law attorney, their chances of a conviction are exponentially increased. A Stark Law defense attorney specializes in healthcare law. Stark Law defense lawyers have the knowledge and training needed to represent the client through the complex legal process. They stand ready to challenge every charge or implication the investigators may bring forth. Year after year, Stark Law Attorneys have successfully defended many healthcare providers.
If you are in the healthcare industry and have been considering an investment in any healthcare facility, the matter should be reviewed by a Stark Law attorney. If you plan to become the owner of a healthcare facility, a health-related institution such as a pharmacy or hospital and especially if you expect to recruit other physician investors creating a joint venture, it is essential that these considerations, amongst others, are reviewed by a Stark Law attorney before proceeding.
Some of the Current Procedural Terminology codes governing healthcare facilities and services:
- Clinical Laboratory Services
- Physical Therapy Services
- Outpatient Pathology Services
- Radiology and Radiology Therapy Services
- Imaging Services
- Durable Medical Equipment and Supplies
- Parenteral and Enteral Nutrients, including Equipment and Supplies
- Prosthetics, Orthotics, including Devices and Supplies
- Home Health Services
- Outpatient Prescription Drugs
- Inpatient and Outpatient Hospital Services
Fraudulent claims and charges against federal programs, as well as state and local healthcare programs, have become so rampant that the federal government, more than ever before is aggressively pursuing and prosecuting every case which they determine to have violated any rule or regulation.
Because of this vigorous attempt to prosecute those who are accused of medical fraud, healthcare professionals are defenseless without the guidance and knowledge of an experienced Stark Law lawyer. The consequences of being found guilty are severe.
If you are ever charged with any healthcare-related violation, call our Stark Law defense attorneys today 888-402-4054.