Stark Law

Overview

First enacted by Congress in 1989, Section 1877 of the Social Security Act (referred to as the, ‘Physician Self-Referral Law’ or more commonly, ‘Stark Law’) was implemented to protect Medicare and other beneficiaries from costs associated with physician referrals for clinical laboratory services with which they had a direct financial relationship with. As part of the Omnibus Reconciliation Act of 1993, Stark Law was further expanded (Section 1903) to prohibit all referrals to ‘Designated Health Services (DHS)’ payable by Medicare with which the physician (or an immediate family member) has a financial relationship, unless an exception applies.

Since then, the Centers for Medicare & Medicaid Services (CMS) have published a number of rules and regulations interpreting the Stark Law statute, defining covered DHS entities, and petalites for non-compliance.

Applicable DHS Entities Covered Under Stark Law

• Clinical laboratory services
• Physical therapy services
• Occupational therapy services
• Outpatient speech-language pathology services
• Radiology and certain other imaging services
• Radiation therapy services and supplies
• Durable medical equipment and supplies
• Parenteral and enteral nutrients, equipment, and supplies
• Prosthetics, orthotics, and prosthetic devices and supplies
• Home health services
• Outpatient prescription drugs
• Inpatient and outpatient hospital services

What Healthcare Organizations Need to Know

There is an exception in Stark Law which allows DHS entities to provide non-monetary compensation to Healthcare Professionals (HCPs) up to an aggregate amount each year (adjusted annually for inflation).

For the calendar year of 2023, if the aggregate amount goes above $489, the DHS provider will face penalties for violating Stark Law including but not limited to civil penalties per violation, exclusion from the Medicare, and a denial of refund from Medicare.

It is up to the DHS provider to track and record non-monetary compensation expenses and any errors or overages are expected to be reported to CMS using the Self-Referral Disclosure Protocol. To Learn more about Stark Law regulations, please visit the CMS website: https://www.cms.gov/.

How Can MedPro Systems Help:

The MedPro Concur Connect suite offers DHS entities a comprehensive approach for monitoring and reporting non-monetary compensation to HCPs to streamline Stark Law compliance.

• MedPro Concur Connect – Expense: Real-time HCP data integration with SAP Concur Expense for commercial operations to capture of all key licensing and demographic data attributes required for Stark Law reporting at the time of the engagement
• MedPro Concur Connect – Export: Automated API extract of Concur Expense files to MedPro’s industry-leading Transparency Reporting solution, MedPro ComplianceReportingID for comprehensive expense tracking and report generation
• Automated Expense Alerts: MedPro ComplianceReportingID will generate daily, weekly, monthly, or custom frequency reports tracking the aggregate spend per HCP against your commercial operations, proactively notifying you of any activates approaching the $489 annual limit