Understanding the Stark Law and its exceptions

Physicians who want to stay out of legal trouble should make sure they understand Stark Law and how it applies to them.

Any physician practicing in New York is probably familiar with the Stark Law, a set of rules that is intended to prevent medical practitioners from referring patients in way that benefit themselves financially. There are many details included as to which specific types of referrals are allowed or prohibited. On top of that, there are a lot of exceptions designed to allow certain acceptable behaviors. Whether they are dealing with a possible or potential Stark Law infraction, or just beginning a new practice, it behooves anybody working in a medical field to understand the Stark Law and how it applies to them.

To whom does the Stark Law apply?

Any physician who makes referrals for Designated Healthcare Services can potentially violate the Stark Law. A few examples of some Designated Healthcare Services that can end up in violation of Stark Law include outpatient and inpatient hospital services, drug prescriptions, and other medical supplies, including prosthetics and orthotics. Other services, such as occupational therapy, physical therapy or services provided in a clinical laboratory can also apply. Basically, anybody attempting a transaction in healthcare from which they could potentially profit will have their actions regulated by Stark Law.

What are the exceptions?

There are certain specialty hospitals to where, even if a physician has a financial interest, he or she may refer a patient. Sometimes the transmission of electronic prescription information involves compensation in a non-monetary form. Such transaction are also allowed. Any DHS other than clinical laboratory services can be submitted to the written advisory opinions of The Secretary. It is ultimately up to the Secretary to determine whether or not a transaction being evaluated for an exception is considered to be at risk to be abused for the physician's benefit.

Is Stark Law outdated?

Originally intended to prevent physicians from abusing their relationship with their patients, there have been numerous exceptions made to the Stark Law. Yet still, there are many things that the Stark Law prohibits doctors from doing that could be beneficial to the patient, and not abusive at all. A doctor is prohibited from giving a patient a scale to monitor his or her weight, providing a cab ride for a patient to get to and from an appointment and from advising patients as to their post-care facility options. As Stark Law frequently comes under review, more of its regulations may yet prove to be outdated.

If a medical practitioner in the New York area has had his or her transactions come under review for a Stark Law infraction, or if he or she is seeking to better understand the prohibitions of Stark Law, an attorney in the area who practices health care law may be able to provide legal guidance and answers to legal questions.