About Fraud & Abuse and Stark
The phrase “fraud and abuse” covers issues related to a wide array of state and federal laws regulating the provisions of health care. Our attorneys are experienced in analyzing each of these laws to assist in identifying risks and analyzing arrangements to assure compliance. Whether it is an issue that involves a possible kickback, a payment for a referral, a plan that possibly constitutes prohibited “gainsharing,” or issues involving contracting with excluded individuals, our experience allows us to propose relevant, practical solutions.
The so-called “Stark” law prohibits physicians from referring Medicare and Medicaid services to an entity if they have a financial relationship with the entity, and that financial relationship does not fit in one of the many available exceptions. This referral prohibition applies to eleven categories of “designated health services,” which, together, comprise nearly the full spectrum of health care services, from inpatient and outpatient hospital services, to home health and outpatient prescription drugs. While the legislative prohibitions and exceptions are relatively clear, the interpretive regulations issued by CMS are highly technical, detailed, and oftentimes counter-intuitive. Our team has fully analyzed the laws and regulations available to date, and we routinely advise clients about how to comply in this complex regulatory area.