Page 12 - COM Outlook - Spring 2013

12 COM Outlook . Spring 2013
HEALTH CARE LEGAL EAGLE
Patient Referrals and Financial
Relationships: Laws You’ll
Need to Know
By Fred Segal, Esq.
These laws regulate patient referrals and fi-
nancial relationships involving medical practic-
es, testing facilities, surgery centers, hospitals,
and other businesses.
The federal Anti-Patient Self-Referral Act
(Stark Law) provides that neither a physician
nor his or her immediate family members
may make a referral to an entity or make or
cause to be presented a claim to the Medicare
program (or any other federal health care pro-
gram) or any individual, third-party payer, or
other entity, for certain health services (among
these are lab and radiology services) if such
physician or family member has a financial
relationship with such entity.
For example, you can’t own an imaging center
and send all of your patients there just so you
can make money (unless you meet an exception
to the statute).
Since the majority of physicians will be involved,
in some way, in billing Medicare for reimburse-
ments for the services you provide, most of you
will likely be under the auspices of the Stark Law
in some fashion. One of the most common sce-
narios in which the Stark Law will apply is when a
physician has an ownership interest in a business
that provides ancillary services (such as a testing
lab or a surgical center) and the physician refers
patients to that ancillary business.
The Stark Law is subject to certain exceptions
that most physicians try to use to avoid the
restrictions. For example, the in-office ancillary
services exception allows group practices (as
defined in the statute) to refer patients for an-
cillary services to a company that has a financial
relationship with the group.
The federal Anti-Kickback Statute prohibits
one party to provide or offer to provide any-
thing of value in order to induce the referral of
health care services that will be billed to the
Medicare program (or any other federal health
care program). A common way a physician
gets in trouble is when he or she is paying the
referral source money specifically for the pur-
pose of the referral source referring Medicare
patients to the provider.
Because the statute is so broad (technically,
getting free coffee at the hospital could be a
violation), the U.S. Department of Health and
Human Services Office of Inspector General has
throughout the years adopted certain safe har-
bors that protect providers and business from
prosecution if such providers and business fall
within the parameters of said safe harbors. For
instance, the space rental safe harbor allows
a physician to refer patients to a group from
whom he or she is leasing space if six standards
(described in the safe harbor) are met.
Florida also has enacted statutes that in some
ways mirror the Stark Law and the Anti-Kick-
back Statute. These laws—the Florida Patient
Self-Referral Act, the Florida Patient Broker-
ing Act, and the Florida and federal kickback
statutes—carry with them severe penalties for
noncompliance, such as stiff fees and, in some
cases, jail time.
While you may not be subject to these laws for
a long time, you almost certainly will be hear-
ing about and dealing with them throughout
your medical career. If you want to get a head
start in learning about them, attorneys Lester
Perling, a board-certified health law attorney
and partner in my firm Broad and Cassel, and
Alan Gassman, a board-certified estate plan-
ning lawyer, have authored the newly-released
A Practical Guide to Kickback and Self-Referral
Laws for Florida Physicians , which is available
at amazon.com.
I know you are still
in the early stages of
your medical career,
but as an attorney
who works with
doctors daily, I feel
it is my obligation
to teach you about
some of the laws you
will frequently come
across throughout
your career. This ar-
ticle will briefly intro-
duce two of the most
important and com-
plex laws physicians
will encounter: Stark
Law and the Anti-
Kickback Statute.
Fred Segal is an attorney in the
Miami office of the statewide law
firm Broad and Cassel, where he is
a member of the Health Law Practice
Group. After earning a bachelor’s
degree from the University of Florida,
he earned his Juris Doctorate from
NSU’s Shepard Broad Law Center
and then completed a Master
of Law degree in Health Law at
Widener University School of Law in
Wilmington, Delaware, in 2008.