Enforcers
of
anti-kickback
laws
are
turning
up
the
heat
on
hospitals,
health
systems
and
physicians
alike,
with
2024
on
track
to
see
ever
increasing
penalties
and
stress
on
providers.
Commonly
known
as
the
Stark
Law,
the
Physician
Self-Referral
Law
(42
U.S.C.
§1395nn)
of
1989
prohibits
physicians
from
referring
patients
to
receive
“designated
health
services”
payable
by
Medicare
or
Medicaid
from
entities
with
which
the
physician
or
an
immediate
family
member
has
a
financial
relationship,
unless
an
exception
applies.
The
goal,
of
course,
is
to
prioritize
helping
patients
obtain
the
best
available
care
over
physician
self-dealing.
Healthcare
providers
who
believe
they
may
have
violated
the
Stark
Law
may
report
possible
infractions
within
six
years
through
a
self-referral
disclosure
protocol
(SRDP).
Experts
generally
applauded
updates
to
Stark
implemented
in
2020
designed
to
relieve
Stark
administrative
burdens.
Then,
in
early
2023,
the
Centers
for
Medicare
&
Medicaid
Services
again
revised
the
protocol
in
an
aim
to
streamline
SRDP
submissions.
As
a
result,
from
2021
to
2023,
self-disclosures
rose
from
27
to
176
–
a
552%
increase.
Perhaps
one
motivating
factor
is
the
burgeoning
size
of
Stark
settlements.
For
example,
late
last
year,
Community
Health
Network,
Inc.,
of
Indianapolis,
agreed
to
pay
$345
million
to
resolve
alleged
Stark
violations
–
an
all-time
record.
The
settlement
sprang
from
U.S.
Department
of
Justice
charges
that
senior
management
conspired
to
hire
physicians
from
private
practices
at
as
much
as
double
their
salaries
for
the
purpose
of
capturing
“downstream
referrals.”
A
whistleblower
former
executive
reported
the
scheme
in
2014
under
the
False
Claims
Act’s
(FCA)
qui
tam
provisions.
In
another
qui
tam
case,
regional
hospital
operator
Covenant
Healthcare
Systems
and
two
of
its
physicians
agreed
to
pay
more
than
$69
million
in
a
suit
brought
by
a
former
physician-executive
for
improper
financial
relationships
between
Covenant
and
its
doctors.
More
typical
is
a
$1.8
million
fine
in
March
this
year
against
a
Houston
neurologist
for
allegations
of
Medicare
and
Medicaid
billing
for
medically
unnecessary
services
and
for
referring
patients
to
his
own
diagnostic
centers.
However,
critics
say
that
the
widened
Stark
enforcement
net
is
not
only
catching
more
offenders
but
is
simultaneously
squeezing
physicians
unfairly.
Ramped-up
FCA
and
Stark
enforcement
is
throwing
doctors
into
a
vise
between
patients
and
corporately
owned
and
managed
hospitals,
health
systems
and
medical
practices,
argues
Harry
Severance,
MD,
a
high-profile
author
and
frequent
public
speaker
on
healthcare
policy
and
workplace
safety.
As
private
equity
firms
and
business-focused
management
teams
increasingly
take
control
over
American
healthcare,
doctors
complain
that
pressure
to
increase
provider
productivity
and
profitability
is
approaching
intolerable
levels.
Patient
care
subsequently
suffers.
Management
boards
typically
function
without
physician
members
and
defend
their
earnings-focused
decisions
as
“common
business
practice,”
says
Dr.
Severance,
adjunct
assistant
professor
at
Duke
University
School
of
Medicine.
While
acceptable
outside
of
healthcare,
such
conduct
tends
to
draw
doctors
into
risking
FCA/Stark
violations,
sometimes
unknowingly
as
guidelines
and
regulations
grow.
Dr.
Severance
points
to
research
finding
that
primary
care
physicians
need
26.7
hours
per
day
just
to
follow
nationally
recommended
guidelines
for
preventive
care
while
also
seeing
patients.
“[I]f
there
are
no
practicing
physicians
on
board,
my
legal
sources
tell
me
that
it’s
much
easier
to
avoid
federal
oversight
and
federal
inquiry,
especially
if
presented
as
‘common
business
practice,’…”
Dr.
Severance
told
Becker’s
ASC
Review.
Photo:
adventtr,
Getty
Images