Stark Law Essay

Stark began as a way to combat the abuse of doctors referring patients to clinics for tests in which they had a financial interest. Today it primarily deals with the hospital level and has seen compliance gained through the use of qui-tam lawsuits brought by non-governmental relators. Subpart A of this section will lay out the creation of Stark, the initial statute that created it and the many implementation phases and alterations it has gone through in its twenty-five plus year history. Subpart B will lay out some basic definitions that are necessary to understand the various elements of Stark violation. And Section C will give an introduction to the brief history of the SRDP.

A. Stark Law: A Brief History

Stark was originally enacted

Phase I addressed basic statutory definitions, general prohibitions, and explanations of what constitutes a financial relationship between a physician and a health care entities providing DHS’. Phase II deals with the regulatory exceptions, reporting requirements, and public comments pertaining to Phase I. Finally, Phase III Final Regulations were published in September of 2007, and largely addressed comments made after publication of the Phase II rules and regulations. It also reduced some of the regulations placed upon the healthcare industry by explaining and modifying some of the exceptions related to financial relationships between physicians and DHS entities where there is minimal risk of abuse to the patient, Medicare or Medicaid.

Violations of Stark can come at a hefty price. The statute provides for the following sanctions on claims submitted for DHS in violation of Stark: (1) denial of payment; (2) requiring refund of funds received; (3) civil penalties of $15,000 per service if the violation is knowing; and (4) exclusion from Medicare or Medicaid programs where a physician or entity knowingly enters into an improper cross-referral arrangement or scheme in order to skirt the self-referral