Stark Law And The Anti-Kickback Statue (DHS)

Stark Law was created with the purpose of forbidding providers from self-referring Medicare patients to others Medicare payable facilities for designed health services (DHS), where providers or one of their immediate family members has the direct or indirect financial relationship (Cleverly & Cleverly, 2017, p. 108). The law states that providers cannot bill Medicare or Medicaid for services provided under the disallow referrals and Medicare and Medicaid will not pay for those services. Violation of the law can results in the civil fines of up to $15000 per claim plus the double amount of reimbursements and $100000 for deliberately sidestep the law. Therefore, violation of the law by sending claims for small amounts of money to Medicare and

Violators may face criminal charges by fine of up to $25000 and/or five years in prison. Violators can also be eliminated from federal healthcare programs. The law states that anyone who exchanges or receives valuable things as rewards for referring patients for payable Medicare and Medicaid services will violate the AKS. The law also bans payments in returns for ordering, leasing, or purchasing goods or services that are payable from Medicare and Medicaid. Therefore, healthcare organizations and providers need to carefully form their relationships in order for not violating the law. The Safe Harbor Regulations provide exceptions to allow providers and healthcare organizations to avoid violations of the Anti-Kickback law, which outline that certain payments and business practices that are shield from the criminal offense under the AKS. For example, according to the AKS, it is criminal charge if organizations make payment to providers as referrals commissions. The Safe Harbor provides exception for healthcare organizations to arrange payments to persuade providers to join the organizations if the following conditions are met: if the providers are leaving the current practices, the providers can only refer 25% worth of patients to the new practices and the recruiting organizations must obtain 75% of their revenue from new patients; the agreements of joining new organizations must not be based on the conditions that providers refer patients to new practices in exchange for benefits of the employments (Vandenack Weaver LLC). Therefore, when making financial decisions for organizations in contracting with new providers or practices, healthcare organizations must consider all contract conditions to ensure the compliance with the