Oberheiden, P.C. Blog

What Is the Difference Between a Physician Self-Referral and a Kickback?

Categories: Health Care Law

For physicians and other health care providers, navigating the statutory and regulatory restrictions on billing for reimbursements from Medicare, Medicaid, Tricare, and other government benefit programs presents some of the greatest challenges – and risks – when it comes to legal compliance. Among the laws that apply are the Physician Self-Referral Law (also known as…

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What Are the Rules of Stark Law?

Categories: Health Care Law

Stark Law Exceptions

Physicians who bill Medicare and Medicaid for patient services are subject to numerous laws that are designed to prevent fraud, waste, and abuse in the federal healthcare reimbursement system. One of these laws is the Stark Law, which imposes substantial civil penalties for unlawful “self-referrals.” As a physician, understanding the rules of the Stark Law…

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Investigating Health Care Fraud Through A Civil Investigative Demand (CID)

Categories: False Claims Act

using magnifying glass to investigate fraud

A common approach federal authorities use to investigate health care fraud is through civil investigative demands (CID).  CIDs are requests for documentation that prosecutors issue in connection with a federal investigation.  Compliance with CIDs is required regardless of whether the recipient is charged with a violation or is personally under investigation.  In the context of…

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What You Should Do When You Are Under Stark Law Investigation?

Categories: Health Care Law

Stark Law investigations

About the Stark Law The Stark Law (42 U.S.C. § 1395nn), also known as the Physician Self-Referral Law, imposes limitations on a physician’s right to refer patients to medical service providers in which the physician (or a family member of the physician) has a financial interest or a financial relationship.  The Stark Law only applies…

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What Is the Personal Service Exception under Stark Law?

Categories: Health Care Law

stark law

The Ethics in Patient Referrals Act (Stark) prohibits physicians who have financial relationships with entities from making referrals to those entities for the furnishing of designated health services (DHS) reimbursable by Medicare, subject to certain exceptions. See 42 U.S.C. § 1395nn(a)(1).  To limit the wide and potentially unintended application of this law, the Stark Law…

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