What is the physician self-referral law?
Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation), unless an exception applies. …
Are self referrals illegal?
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.
Can a physician refer to himself?
The Physician Self-Referral Law, also known as the “Stark Law,” generally prohibits a physician from making referrals to an entity for certain healthcare services, if the physician has a financial relationship with the entity.
Does Stark law only apply to physicians?
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 CMS guidelines for referrals?
In a CMS compliant situation, you would 1) ask for referrals without mentioning any benefit to the enrollee and then 2) present a thank-you gift for the referrals he or she has provided. Second, the gifts you provide must be of a nominal value.
Can a physician refer to a lab he owns?
The Stark I law was enacted in 1989 and effective January 1, 1992. The law prohibits physicians from referring their patients to a laboratory with which they or an immediate family member has an ownership or compensation arrangement.
Which of the following is considered to be an illegal provider relationship self referrals?
Which of the following is considered to be an illegal provider relationship? Any person or entity who knows, or should have known, of the presentation of a false or fraudulent claim to the government for payment or approval is subject to .
What is self-referral?
Self-referral is when patients are able to refer themselves without having to see anyone else first, or without being told to refer themselves by another health professional such as a GP.
What constitutes a referral under Stark?
Stark broadly defines “referral” to include a request by a physician for an item or service payable under Medicare or Medicaid (including the request by a physician for consultation with another physician and any test or procedure ordered or performed by such other physician), or a request by a physician for the …
What is self referral in health care?
Self-referral often includes services for drug and alcohol problems, as well as antenatal care and improving access to psychological therapies (IAPT). You can register for most of them online. In some cases you refer yourself by phoning rather than emailing or by completing an online form.
What is a referral under Stark Law?
What is an illegal provider relationship?
When was the physician self referral law passed?
When enacted in 1989, Section 1877 of the Social Security Act (the Act) applied only to physician referrals for clinical laboratory services. In 1993 and 1994, Congress expanded the prohibition to additional DHS and applied certain aspects of the physician self-referral law to the Medicaid program.
Can a physician make a referral for Medicare?
Prohibits a physician from making referrals for certain designated health services (DHS) payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership, investment, or compensation), unless an exception applies.
What does SRDP mean for physician self referral?
The SRDP sets forth a process to enable providers of services and suppliers to self-disclose actual or potential violations of the physician self-referral statute. Additionally, Section 6409 (b) of the ACA, gives the Secretary of HHS the authority to reduce the amount due and owing for violations of Section 1877.
Is it illegal to refer a physician to DHS?
In 1997, Congress added a provision permitting the Secretary to issue written advisory opinions concerning whether a referral relating to DHS (other than clinical laboratory services) is prohibited under section 1877 of the Act.