If you have a license to practice medicine, you must comply with the Stark law. This anti-kickback statute, named after late U.S. Representative Peter Stark, prevents doctors from making certain medical referrals.
In addition to potential criminal charges or civil liability, a violation of the Stark law may lead to a complaint with your medical licensing board. To protect your license, you must understand the basic parameters of the law.
Basic prohibitions
Public policy dictates that patients receive the best care when their physicians refer them to the right specialists. If you treat Medicare or Medicaid patients, you likely cannot legally refer a patient to a designated health service in which you have a financial interest. You also probably cannot refer patients to a close family member.
Notable exceptions
If you are facing disciplinary action because of an alleged violation of the Stark law, you may be able to show your referral fell within one of the law’s approximately 20 exceptions. The following are some notable ones:
- The referral is part of a prepaid health plan
- You have a legitimate employment relationship with the designated health service
- The designated health service is a public hospital
- The designated health service provides medical care in a geographically rural or medically underserved area
To avoid running afoul of the Stark law, you must understand the difference between legitimate and illegitimate Medicare and Medicaid referrals. Fortunately, while Stark law violations are often serious matters, you likely have some options for defending yourself and protecting your medical license.