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

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...

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What Are the Rules of Stark Law?

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...

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

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...

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

  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...

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What Is the Personal Service Exception under 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...

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What Are the Compensation Arrangement Exceptions to the Stark Law?

Under the Physician Self-Referral Law (42 U.S.C. § 1395nn), or Stark Law, physicians are barred from referring Medicare/Medicaid beneficiaries to a “designated health services” (DHS) provider in which the referring physician (or his immediate family member) has a “financial relationship.” Because maintaining the Stark Law without exceptions would make the...

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What Are the Ownership and Investment Interest Exceptions to the Stark Law?

The Stark Law, officially named the Physician Self-Referral Law (42 U.S.C. § 1395nn), forbids physicians to refer a Medicare/Medicaid patient to a “designated health services” (DHS) provider that the referring physician (or his immediate family member) has a “financial relationship” with, unless an exception applies.  Similarly, the Stark Law disallows...

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Defending Physicians against Kickback Charges in Connection with PGX Testing

  Laboratory Kickback Prosecutions Since 2014, when the Department of Health and Human Services’ Office of the Inspector General released a Special Fraud Alert regarding improper payments by laboratories to referring physicians, federal investigators have increasingly focused on the relationships between laboratories and physicians.  Federal investigators are particularly on the...

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Defending Toxicology Labs In Stark Law Investigations

  Dr. Nick Oberheiden, Esq. www.federal-lawyer.com (214)-692-2171 Including Weekends Current Toxicology Laboratory Investigations Recently, toxicology laboratories have faced increased scrutiny from federal investigators looking for improper relationships with their referring physicians.  Toxicology laboratories with close ties to drug treatment centers are receiving particular attention regarding referrals for urine testing. In...

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Important Differences between the Anti-Kickback Statute and Stark Law

  Dr. Nick Oberheiden, Esq. www.federal-lawyer.com (214) 692-2171 Including Weekends What works in other industries, often does not work in the healthcare industry. It is important to understand that while it is absolutely common to pay for business on a quid-pro-quo basis in many any other industries, healthcare laws strictly...

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