Stark Law Revisions Just One of Many Factors Driving Value-based Care

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The Department of Health and Human Services released final rules on November 20, 2020 with changes to the Physician Self-Referral Law (Stark Law) and the Anti-Kickback Statute (AKS) to facilitate care coordination and value-based care. In this article we discuss the Stark Law, AKS and changes thereto, as well as implications. An operational “bottom line” perspective is also provided.

Stark Law and Anti-Kickback Statute -

The Physician Self-Referral Law, also known as the Stark Law, prohibits physicians from referring patients to “designated health services” that are payable by Medicare or Medicaid from entities with which the physician or an immediate family member has a financial relationship, unless an exception applies. Financial relationships include both ownership and investment interests, as well as compensation arrangements. “Designated health services” include clinical lab services, physical therapy, occupational therapy and outpatient speech-language pathology services, radiology, DME and supplies, parenteral and enteral nutrients, prosthetics, home health services, outpatient prescription drugs, and inpatient and outpatient hospital services...

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