Quick Answer: Does Stark Law Apply To Private Insurance?

Does Anti Kickback Statute apply to private insurance?

In October of 2018 Congress enacted a new law that applies to many commercial health insurance plans, as well as Medicare and Medicaid.

Unfortunately, these provisions create expansive anti-kickback penalties for all private and commercial pay business.

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Who does the Stark law apply to?

The Stark statute applies only to physicians who refer Medicare and Medicaid patients for designated health services to entities with which they (or an immediate family member) have a financial relationship. There are almost 20 exceptions to the Stark statute.

What are exceptions to the Stark law?

There are multiple exceptions to the Stark Law that permit physicians, in certain limited circumstances, to make referrals for federally-covered designated health services. … Fair Market Compensation Exception – A second useful exception to the Stark Law allows for fair market value compensation.

What is the difference between the Stark Law and the Anti Kickback Statute?

The AKS prohibits referrals for any kind of item or service where a kickback is involved, while the Stark Law prohibits only the referral of designated health services where a financial interest is involved.

What is an example of the Anti Kickback Statute?

The Anti-Kickback Statute The illegal kickbacks can be cash payments, but often include other items of monetary value, such as gifts, free or discounted supplies or services, and travel. … For example, they might pay doctors inflated rates for speaking engagements or pay above fair market value to lease office space.

Do Stark laws apply to employed physicians?

Both the Stark Law and the Anti-Kickback Statute contemplate employment of physicians by hospitals, and accordingly, both include an exception to accommodate the compensation paid by a hospital employer to a physician employee.

What is the Stark law in healthcare?

The Physician Self-Referral Law, commonly referred to as the Stark law, prohibits physicians from referring patients to receive “designated health services” payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies.

What situation is a written agreement not required under Stark?

For example, the following exceptions to the Stark Law require a written, signed agreement: office space and equipment rental, personal service arrangements, physician recruitment arrangements, group practice arrangements, and fair market value compensation arrangements. 42 C.F.R. 411.357.

Does Stark law apply to pharmacies?

The Stark Law applies to all relationships that physicians have with designated health services entities, and pharmacies are classified as such. Because of this, referral relationships between physicians and pharmacists can be scrutinized through the lens of the Stark Law.