Home Health & Hospice

Q: Is there a simple way to determine whether a physician is violating the Physician Self-Referral Law?

Homecare Insider, February 4, 2014

 

Q: Is there a simple way to determine whether a physician is violating the Physician Self-Referral Law?
 
A: The Physician Self-Referral Law, also known as the Stark Law, prohibits a physician from referring Medicare patients for services with which the physician, or an immediate family member, has a financial relationship, unless an exception applies. It further prohibits the provider from submitting claims for those services resulting from a prohibited referral. In fact, the law makes mention of the physician referring to "designated health services," and home health is a designated health service.
 
The Health Care Fraud Prevention and Enforcement Action Team suggests three questions to ask when analyzing the Physician Self-Referral Law:
  1. Is there a referral from a physician for a designated health service? If yes, go to question 2.
  2. Does the physician (or an immediate family member) have a financial relationship with the entity providing the designated health service? If yes, go to question 3.
  3. Does the financial relationship fit into an exception? If not, there is a possible violation.
For more information on the Physician Self-Referral Law, including a list of exceptions, go to www.cms.gov/PhysicianSelfReferral.