Physicians in the Washington, D.C. area often cultivate an extensive professional network through their everyday practices. This often serves to benefit their patients, as such contacts provide points of referral for different cases that might fall outside of the doctor’s particular specialty.
A general assumption exists amongst such practitioners that most people understand this. Yet many clinicians come to us here at RaquinMercer LLC expressing great surprise when facing accusations of violating the Stark Law Prohibition (the law prohibiting kickbacks between doctors with established financial relationships). Yet simply because a referral occurred in a scenario where such a relationship exists may not necessarily mean that a violation took place.
Stark Law exceptions for admissions
Indeed, according to the American College of Pathologists, exceptions exist that allow providers to refer patients within their own established financial networks. For example, a doctor may refer a patient for admission to an academic medical center when the following conditions exist:
- The doctor is a bona fide employee of the center and its associated medical school
- The doctor has a license to practice medicine in the state
- The doctor provides substantial academic and/or clinical services for which they receive compensation
In addition, a doctor may refer patients to an ambulatory surgical center for certain implant services provided they perform the implantation (or a member of their medical group does) and the center furnishes the implant.
Referrals within a medical group
Beyond admissions, the Stark Law exempts referrals made by a physician to another clinician within their medical group (or a clinician supervised by a member of their medical group) or for services provided within the same building in which the physician practices (and the referred services are not the primary reason the patient requires care).