Focus On Fraud And Abuse: First Settlement Under the Voluntary Self-Referral Disclosure Protocol

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The first Stark settlement since the publication of the CMS Voluntary Self-Referral Disclosure Protocol (SRDP) was announced on February 10, 2011. Saints Medical Center in Lowell, Massachusetts settled with CMS for alleged violations relating to issues with night coverage, medical directorships, and stipends. CMS settled the issues for $579,000, and while CMS won’t reveal the initial overpayment calculation amount, CMS has reported the settlement to be substantially less. A statement released by the hospital as well as local media reports indicate that the hospital’s Stark violations could have triggered a potential repayment amount between $785,000 and $14.5 million.

CMS has revealed very little about the settlement. During a speech at the AHLA Physician’s Organization and Hospital and Health Law meeting in February, Troy Barsky, Director, Technical Payment Policy, announced the settlement and stated that future settlements would be issued on a regular basis and would likely be announced quarterly. Mr. Barsky also announced at the meeting that, to date, approximately 50 self-disclosures have been submitted through the SRDP. A handful have been accepted; for others, CMS has requested additional information. Until more settlements are issued, and with minimal details disclosed by CMS, it will remain difficult to predict the outcome of disclosures for providers contemplating use of the Stark Self-disclosure Protocol for correcting Stark violations. Accordingly, providers should carefully consider their various options for correcting Stark issues, including filing a self-disclosure under the SRDP.

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Published In: Administrative Agency Updates, Health Updates

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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