Healthcare providers must navigate and comply with a staggering number of complex federal and state rules and procedures to avoid running afoul of the law. Among the most important of those laws is the federal physician self-referral law, commonly referred to as the “Stark Law.” The State of Florida has a corresponding state statute that is modeled after federal law. A violation of the Stark Law could result in hefty fines and penalties as well as exclusion from federal health care programs.
If you are a physician, or another healthcare provider, who is being investigated for an alleged violation or who has been formally charged with a violation of the Stark Law, you need an experienced Florida Stark Law defense attorney on your side immediately. Attorney Jonathan Rose has the experience and resources necessary to protect your rights and your career if you are involved in an alleged violation of the Stark Law.
What Is the Stark Law?
U.S. federal laws attempt to provide oversight to physicians, hospitals, and health care programs to protect everyone involved. Just as those laws prohibit kickbacks by physicians, the Stark Law, which is part of the Social Security Act and is governed by 42 U.S.C. § 1395nn prohibits physician self-referrals. Specifically the Stark 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.
- Prohibits the entity from presenting or causing to be presented claims to Medicare (or billing another individual, entity, or third-party payer) for those referred services.
- Establishes several specific exceptions and grants the Secretary the authority to create regulatory exceptions for financial relationships that do not pose a risk of program or patient abuse.
The State of Florida enacted similar legislation that closely mimics the federal Stark Law. Known as the Florida Patient Self-Referral Act, it can be found in Section 456.053 of the Florida Statutes and prohibits conduct similar to that prohibited by the federal Stark Law.
Potential Penalties for a Violation of the Stark Law
If convicted of violating the Stark Law, both your medical practice and your career could be at considerable risk. A violation of the federal Stark law carries with it potential penalties that include:
- Denial of payment from the relevant health care program
- An order to refund payment already received
- Future exclusion from federal health care programs
- Imposition of a $15,000 per service civil monetary penalty
- Imposition of a $100,000 civil monetary penalty for each arrangement considered to be a circumvention scheme.
- Criminal penalties if convicted of criminal offenses related to the Stark Law violation
Defending Against Allegations of a Stark Law Violation
If you are being investigated by the federal government for a Stark Law violation, the investigation will likely be complex and lengthy, involving several federal law enforcement agencies. By the time you become aware of the investigation, or you are arrested, the government will likely have amassed a considerable amount of potentially damaging evidence against you and/or your medical practice. Getting an experienced defense attorney on board as soon as possible is the key to protecting your rights and constructing a winning defense.
The good news is that there are several common defense strategies that might be applicable in your case if you have been accused of violating the Stark Law. For example, there are over 30 exceptions to the prohibition against physician self-referrals in the federal law, including referrals made to another physician in the same medical group/partnership or a referral made within a prepaid health plan.
Another potential avenue for defending you against an alleged violation of the Stark Law is to prove that the referral did not involve a “designated health service” as defined by the Stark Law or the corresponding Florida law.
An important thing to know about defending an alleged violation of the Stark Law is that strict liability applies. This means that the government does not have to prove that you intended to violate the law, only that you did violate the law. This makes it even more important to get an experienced defense attorney on your side as early in the process as possible.
Contact an Experienced Florida Stark Law Defense Attorney
To successfully operate a medical practice, you cannot afford to run afoul of the state or federal government’s laws and regulations. Because those laws are so convoluted and even conflicting at times, you need a seasoned defense attorney to interpret the applicable law and navigate the judicial system for you. You also need a strong advocate for you to make your rights are protected during an investigation and/or prosecution if you have been charged with violating the Stark Law. Contact an experienced Florida Stark Law defense attorney at Jonathan Rose P.A. today by calling 407-894-4555 or filling out our online contact form.