HISTORIC CHANGES TO STARK LAW AND ANTI-KICKBACK STATUTE REGULATIONS BY OIG AND CMS.

CMS has finalized changes to outdated federal regulations, such as the Stark Law, which have saddled health care providers with more administrative costs and impeded the advancement of the health care system toward value-based reimbursement. To know more about these changes and Anti-Kickback Statute Reforms, read along!

CMS has finalized changes to obsolete federal regulations that have saddled health care providers with more administrative costs and impeded the health care system’s move toward value-based reimbursement. Also known as the “Stark Law”, the Physician Self-Referral Law prohibits a physician from making referrals to an entity for certain healthcare services if there is a financial relationship with that entity.

Background:

The Stark Law forbids a physician from making referrals for certain healthcare services payable by Medicare if the physician (or an immediate family member) has a financial relationship with the individual rendering the service. In 1989, when the time Stark Law was established, healthcare was paid for primarily on a fee-for-service basis. The law recognized that some physicians could be motivated by financial gains to request services based on their financial self-interest instead of the good of the patient. There are, however, statutory and regulatory exceptions to this rule. Additionally, the Stark Law forbids the entity from filing claims with Medicare for services resulting from a prohibited referral, and Medicare is not to pay if such claims are filed.

Stark Law Final Rule