News & Analysis as of

Stark Law

Significant Changes in Healthcare Laws Enacted Through the Bipartisan Budget Act of 2018: Stark, Civil and Criminal Penalties,...

by Dorsey & Whitney LLP on

On February 9, President Trump signed the Bipartisan Budget Act of 2018 (“BBA”) into law. The BBA funds the federal government through March 23 and included a bipartisan agreement to increase annual spending authority for a...more

Significant Health Policy Changes Contained in Bipartisan Budget Act of 2018

by King & Spalding on

On February 9, 2018, after passing the House and Senate, the President signed into law the Bipartisan Budget Act of 2018 (BBA). The BBA amends the Budget Control Act of 2011 (BCA) to increase the spending caps on both defense...more

Stark Law Reform a Focus of Recent Regulatory and Legislative Initiatives; 2018 DHS Code List and CPI-U Updates

by Dorsey & Whitney LLP on

The Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma recently identified federal physician self-referral law (or “Stark Law”) reform as a top policy priority and reported that an inter-agency group is...more

CO Senate Proposes Bills Expanding Self-Referral Prohibition And Affecting Freestanding ERs

by Husch Blackwell LLP on

Bill Would Extend Colorado Mini-Stark Law to Services Reimbursed by Private Payors On January 29, 2018, Colorado State Senator Irene Aguilar introduced SB 18-115, titled “Apply Stark Laws to Medical Referrals Outside...more

Third Circuit Rejects False Claims Act Theory that Anti-Kickback Violations "Taint" All Related Claims

by Jones Day on

The Situation: A provision in the False Claims Act ("FCA") had clarified when Anti-Kickback Statute ("AKS") violations can make a claim false, but the provision's rule of per se falsity does not answer when a claim "result[s]...more

2017 – The Health Law Year in Review

Uncertain. What better word to describe a year in which a new administration came to power and began to chart a new course for health policy, the fate of the Affordable Care Act (ACA) hung in the balance, and courts grappled...more

OIG Reaffirms Permissibility of Certain Gainsharing Arrangements

The Department of Health and Human Services Office of the Inspector General (OIG) has issued an Advisory Opinion (Opinion) in connection with a hospital’s gainsharing arrangement (Arrangement) with a designated group of...more

CMS Approves Laboratory Alerts to Physicians in Rare Stark Law Advisory Opinion

The Centers for Medicare & Medicaid Services (CMS) issued a rare advisory opinion (CMS-AO-2017-1) under the Stark Law (Section 1877 of the Social Security Act, codified at 42 U.S.C. § 1395) earlier this fall, addressing a...more

Courts May Not Review CMS’s Determination to Grant or Deny a Hospital’s Expansion Application Under Stark

by King & Spalding on

In a decision issued on November 21, 2017, the D.C. Circuit affirmed the district court determination that the Affordable Care Act (ACA) bars judicial review of CMS’s determination to grant or deny a hospital’s Stark Law...more

Recent Case Highlights Risks of Paying Physicians for Routine Duties - Signed writing required, informal documentation may not be...

by Stinson Leonard Street on

Payments to physicians, even for routine, necessary duties, may cause referrals to the entity making the payments to be "prohibited referrals" under the Stark Law. This means the hospital or other entity should not have...more

“Always a bridesmaid, never a bride” Might Work for Stark Liability but Not the Anti-Kickback Statute

by Nossaman LLP on

Last Thursday, a jury in federal district court in St. Louis handed down a verdict in a False Claims Act (“FCA”) case that presents a laundry list of the challenges which can arise in a FCA case. ...more

Hospital and Medical Group Settle Stark Law Case for $20.75 million

by King & Spalding on

A Pennsylvania hospital and physician group settled whistleblower fraud allegations for $20.75 million the day before jury selection was set to begin in U.S. District Court of the Western District of Pennsylvania in a suit...more

New Legislation Offers Major Reforms to the Physician Self-Referral Prohibition (the 'Stark Law')

Last week, bipartisan legislation was introduced in the House and Senate to make significant reforms to the Stark Law, which bars a physician from referring patients to an entity with which the physician has a financial...more

"Insider" Edition—Required Referrals and the Stark Law (Part Two of Two)

Hospitals and physicians must consider many items when a hospital is putting together an employment contract with a physician. One question we have seen more and more hospitals ask is whether a hospital may insert a provision...more

Will the Massachusetts Proposed Legislation on Hospital Outpatient Facility Fees Have a Nationwide Impact?

by Foley & Lardner LLP on

In some states, including the Commonwealth of Massachusetts, “site neutrality” for outpatient hospital reimbursement is factoring into state-specific health reform and cost containment initiatives. This potentially goes...more

"Insider" Edition—Required Referrals and the Stark Law (Part One of Two)

When a hospital is putting together an employment contract with a physician, there are many items for both the hospital and the physician to consider. One question we have seen more and more hospitals ask is whether a...more

CMS Advisory Opinion 2017-01 Approves Pop-up Alerts to Physicians Through Online Laboratory Portal

by Baker Ober Health Law on

A clinical laboratory has received a green light from CMS to offer pop-up notifications alerting physicians of various potential issues (Laboratory Alerts) through its web-based portal for ordering and reporting results of...more

Bill That Aims to Ease Stark Penalties Receives House Committee Approval

by King & Spalding on

On Wednesday, September 13, the House Ways and Means Committee gave unanimous approval to H.R. 3726, the Stark Administrative Simplification Act (the “Bill”). The Bill would amend the Stark law, codified at 42 U.S.C. §...more

What Hospitals Need to Know About the Natural Disaster Exception to Stark Law

by Baker Ober Health Law on

Hospitals operating in regions affected by the recent hurricanes and other natural disasters may be able to obtain temporary regulatory relief. During times of disasters and emergencies, CMS can provide some flexibility...more

Six Home Health Providers Agree to Pay $1.8 Million to Settle False Claims Act Liability

by King & Spalding on

On September 5, 2017, the Department of Justice (DOJ) announced that six Tennessee-based home health entities agreed to pay the United States $1.8 million to settle potential violations of the Stark Law and/or Anti-Kickback...more

Hospitals and Others Respond to “Red Tape Relief Project” Requests

Last week, a number of health care industry associations sent letters to Congress detailing ways in which the government could relieve them of the burdens associated with “red tape.” The letters are in response to the first...more

House Bipartisan Act Would Amend Stark Law and Medicare Part B

On July 25, 2017, the U.S. House of Representatives passed by voice vote a bipartisan bill which is now in the Senate’s hands for consideration, the Medicare Part B Improvement Act of 2017. The bill would amend the Stark Law...more

With All Eyes on Senate ACA-Repeal Debate, House Passes Bill to Tweak Stark Law and Other Medicare Part B Policies

by Reed Smith on

While the Capitol Hill spotlight is focused on the Senate debate on legislation to repeal or revise the Affordable Care Act, the House of Representatives quietly approved by voice vote HR 3178, the Medicare Part B Improvement...more

Nationwide Healthcare Prosecutions Targeting an Array of Practices . . . Is "Just The Beginning"

by Bracewell LLP on

On July 13, 2017, the Department of Justice ("DOJ"), in conjunction with the Department of Health and Human Services ("HHS"), continued its annual tradition of coordinating the filing of charges and sweeping arrests in...more

Amounts Billed Do Not Indicate Fair Market Value In FCA Case

by Reed Smith on

Our day job has been keeping us busy, so busy with depositions, motions, delayed flights, and assorted drama that we have not posted in more than a month. After such a long layoff, we had hoped to return with a vengeance, a...more

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