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Stark Law Violations

With concerns about federal healthcare fraud on the rise, alleged violations of the Stark Law have increasingly come to the forefront of attention in Michigan. While the law started with a relatively simple premise, amendments have made the Stark Law increasingly complex. Currently, it is even possible to violate the statute without realizing it.

Given how severe the consequences of Stark Act violations may be, it is often wise to take prompt action if a violation is suspected. A Michigan Stark Law violations lawyer can provide representation and advice if you are being investigated in connection with referrals or other potential violations. If applicable, your knowledgeable healthcare fraud attorney can also assist in establishing a program to work toward compliance in the future.

Penalties and Other Consequences of Stark Act Violations

Violations of the Stark Law may result in serious sanctions. 42. U.S.C. §1395nn(g) specifies first that the provider will not receive payment for services provided in circumstances that violate the law, and that any money collected in violation of this statute's provisions must be refunded.

The provider may also be liable for civil penalties of up to $15,000 for each service provided in violation of the law, and for a fine as high as $100,000 for attempts to circumvent the law. Failure to fulfill reporting requirements might subject a provider to fines of $10,000 per day for each day missed. Violators could also be excluded from participating in Medicare and other federal programs in the future.

What the Law Prohibits

The Stark Law essentially creates a ban on physician self-referrals in cases where patients are covered by Medicare or another federal program. A self-referral is a situation where a physician refers patients to a hospital, lab, or another service provider with financial ties to the physician or a member of the physician's family.

Services in Michigan covered by the Stark Law include:

The types of financial connections that violate the Stark Law include ownership interests and many other types of connections. Since liability for violations may arise regardless of whether a provider operated with any intent to violate the law, the Stark Law is often referred to as a "strict liability" law. A Stark Law violations lawyer in Michigan could go into further detail about how interpretations of this law may affect your particular case.

Exceptions to the Strict Liability Law

Further complicating interpretation of the Stark Law is the fact that the expanded law now allows for a large number of exceptions. In these specific cases, it may be permissible for a physician to make referrals which might otherwise be prohibited.

As an example, the in-office ancillary services exception of 42 U.S.C. §1395nn(b)(2) enables a physician to refer to ancillary services provided in the same office. It should be noted that this and other exceptions have their own exclusions. Consequently, it is necessary to pay close attention to every potential referral.

As an example, the in-office ancillary services exception does not permit referrals for durable medical equipment except for infusion pumps. For more information about exclusions to the Stark Law in Michigan, speak with an experienced attorney.

Consult an Experienced Michigan Stark Law Attorney

Stark Law compliance can be difficult, and failure to comply is potentially costly. While lawmakers continue to debate the wisdom of continuing the prohibitions of the Stark Law, it currently remains a force to be reckoned with.

Given that violations carry the potential for such heavy sanctions, it is typically wise for any provider facing allegations of improper physician self-referral to consult a seasoned Michigan Stark Law violations lawyer. A defense attorney with a thorough understanding of Stark Law prosecution could work to devise the best defensive strategy for the situation and advocate to bring about a positive outcome. Call today to learn more about your options.

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