One of the pillars of the medical industry is that the professionals that work in it are unbiased and unaffected by outside influences, especially when it comes to prescribing drugs and medicine or referring patients to other facilities and medical institutions. This is important for obvious reasons, but even well-meaning medical professionals can run afoul of the laws that relate to compliance without even realizing it.
The United States Department of Justice (DOJ) appears to be increasing enforcement efforts regarding violations of the Stark Law and the Anti-Kickback Statute (AKS). These efforts were highlighted in a recent case involving two urologists accused of submitting improper claims. The physicians agreed to pay $1 million to resolve the matter.
A New York science and technology news publication is reporting that a jury recently found the former CEO of a diagnostic testing lab and two marketing executives liable for Medicare fraud under the federal False Claims Act.
Negative publicity began to swirl around now-shuttered Health Management Associates back in 2012 when news magazine "60 Minutes" aired a segment alleging that the hospital chain pressured emergency room doctors to admit patients whether they needed care or not. The pressure on HMA escalated two years later when the New York Times reported that the company inflated its Medicare and Medicaid payments by pressuring physicians to admit at least half of patients age 65 and above.
It is about a 10-hour drive from the densely packed, bustling streets of New York City to the wide open, quiet cornfields and farms of Indiana. The pace of life and the cultures of the two places are worlds apart, but we are also linked by factors common to us both.
The Stark law was named for its co-sponsor, Congressman Pete Stark, but it may as well have been named for its stark treatment of physicians who violate its regulations. The Stark law is considered a strict liability law—that means that anyone who violates it can be penalized, even if they had no intention of committing a violation. Ignorance of the law isn't an excuse, either. A physician who had no knowledge of committing an infraction may still face the penalties.
When two people become engaged to marry, they pledge themselves to a lifetime of love and companionship. But a federal grand jury has said that a neurosurgeon and his fiancée got much than that out of their relationship.
A New York City doctor of internal medicine was recently sentenced to 2 years and 9 months in prison for taking bribes in a scheme that revolved around Biodiagnostic Laboratory Services LLC of New Jersey.
Just a few minutes west of New York City, a former medical imaging center owner is about to be sentenced for his role in a Medicaid fraud scheme. News media reports indicate that his sentencing was delayed for a few days after he was recently hospitalized.
When you first heard of Stark Law, it is possible that you, like many others, assumed it referred to a single statute. Instead, it refers to a whole set of federal laws that regulate physician referrals for Medicare and Medicaid patients. As you likely know, Stark Law generally prohibits doctors from making self-referrals for designated health services (DHS) in which the physician has a financial interest.