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Fraud and Abuse: Referral Issues
  • Federal Antikickback Safe Harbors
  • Gifts and Free Services (Including Promotional Items)
  • Kickbacks and Fee-Splitting: Other Laws Used to Deter Payments for Referrals
  • Physician-Hospital Compensation Arrangements and the Potential for Improper Referrals
  • Professional Courtesy
  • Prohibitions Against Kickbacks and Fee-Splitting
  • Referring Patients: If the Practice Is Not Prohibited Altogether, Is It Safe From Antikickback Prosecution?
  • Self-Referral Prohibitions: California Overview
  • Self-Referral Prohibitions: Federal Exceptions Related to Both Ownership and Investment Interests
  • Self-Referral Prohibitions: Federal Exceptions Related to Electronic Information
  • Self-Referral Prohibitions: Federal Exceptions Related to Managed Care Arrangements
  • Self-Referral Prohibitions: Federal Exceptions Related to Other Compensation Arrangements
  • Self-Referral Prohibitions: Federal Exceptions Related to Rural or Underserved Areas
  • Self-Referral Prohibitions: Federal Overview
  • Self-Referral Prohibitions: Federal Physician and In-Office Ancillary Services, Academic Medical Centers, and Group Practice Exceptions
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Self-Referral Prohibitions: Federal Exceptions Related to Other Compensation Arrangements

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Document: 1164
Chapter: Fraud and Abuse: Referral Issues
Pages:
16

The following is an introduction to the document. To download the full text of the document, please log in.

In general, the federal law (commonly known as the “Stark Law”) prohibits a physician from making a referral to an entity for the provision of designated health services (DHS) payable by Medicare if the physician has a financial relationship with the entity, unless an exception applies, and prohibits the entity from billing for such prohibited services. (42 U.S.C. §1395nn.) Significant penalties are provided for violations and for avoidance schemes. If the ban applies, the physician may not make a referral to the entity for DHS which may be paid for by Medicare and the entity may not, directly or indirectly, bill for any DHS resulting from a prohibited referral to any individual, third party payor, or other entity. A detailed discussion of the “Stark Law” is contained in CMA ON-CALL document #1158, “Self-Referral Prohibitions: Federal Overview.” (California law also contains a self-referral prohibition which recognizes several exceptions that are roughly consistent with federal law. Significantly, however, the state law applies broadly to referrals of all patients, regardless of payor source. The California law is discussed in CMA ON-CALL document #1156, “Self-Referral Prohibitions: California Overview.”)

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  • CMA On-Call
  • Fraud and Abuse

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