Texas Stark Rule Fraud Attorney
The Stark Rule requires physicians and health care providers to disclose any financial relationship they have with a diagnostic lab, emergency treatment center or other medical services to which they refer patients for designated health services, and then bill Medicare or Medicaid for payment. In short, if a doctor has a financial investment in the designated health service, he or she may not bill Medicare or Medicaid for payment.
The Stark Rule differs from the Anti-Kickback Statute by the degree of intent to commit fraud. The Anti-Kickback Statute takes into account intent to commit fraud by purposefully referring Medicare and Medicaid patients to an affiliated clinic, then avoiding the anti-mark up statutes when billing the Centers for Medicare and Medicaid Services. The Stark Rules, however, do not recognize that a physician may not realize that a financial relationship exists. Under provisions of Stark, if the government can prove that the doctor will benefit financially from the referral for outside diagnostic or lab services, CMS will not be required to pay.
Many physicians don't realize when a financial relationship exists between their clinic and the diagnostic lab and, therefore, inadvertently run afoul of the Stark Rules.
Don't Wait to See Whether the Attorney General Will Investigate
If you realize that you have inadvertently violated provisions of the Stark Rules, the Office of the Attorney General(OAG) makes it possible to negotiate a financial settlement that is typically substantially less than the total amount that may be required for full restitution. If the OAG investigates and discovers that you were aware of the financial relationship with the outside service provider, you will face full restitution, plus penalties and interest on the money repaid to the government.
Negotiating a fair settlement with the OAG requires knowledge of the Stark Rules, extensive record keeping of timelines for referrals and payments and a firm understanding of what the attorney general will accept. The health law team at Kerr, Hendershot & Cannon have decades of experience representing physicians and health care providers in all areas of Medicare and Medicaid billing. Our health law attorneys work aggressively with the OAG to negotiate the lowest repayments possible and fight aggressively to avoid criminal stemming from Anti-Kickback and Stark Rule violations.
Texas Physician Self-Referral Law Lawyer You Can Rely On
From our offices in Houston, our Texas Stark Law fraud lawyers represent medical professionals in communities throughout South Texas. Contact us to arrange a consultation about your self-disclosure concerns today.
