The United States Department of Justice (DOJ) appears to be increasing enforcement efforts regarding violations of the Stark Law and the Anti-Kickback Statute (AKS). These efforts were highlighted in a recent case involving two urologists accused of submitting improper claims. The physicians agreed to pay $1 million to resolve the matter.
What was the basis for the allegations? The DOJ claims the physicians were in violation of the location requirements of a specific exception within the Stark Law.
This requirement is part of the “in-office ancillary services” exception. This exception basically allows for a referring physician to reap a financial benefit from a referred service. Three components are required to meet this exception: performance, location and billing. A basic summary of these components follows:
- Performance: by the referring physician, a physician that is a member of the same practice or by professionals supervised by the referring physician
- Location: within a building where the referring physician or another from the same group practices in a manner unrelated to the service referred or where lab services are completed
- Billing: by the physician performing the services or the physician’s group practice
The DOJ claimed that the group did not meet this definition.
It is difficult to determine the extent of evidence present to support this claim, as the physicians who were accused of this violation chose to settle as opposed to fight the allegations. Regardless, the case could serve as a sign that the agency is increasing its scrutiny of these practices.
What are the lessons for practices facing similar allegations? First, physicians groups should note that the DOJ is reviewing claims and watching for these violations.
The fact that the group in question settled draws attention to the complexity of these laws and the importance of legal counsel for any group facing similar accusations. It is important to note that the definitions provided in this piece are broad. A full application of the exception to a specific legal issue would require careful review of the minutiae of the language of the law, including confirmation that the practice fits the Stark Law’s definition of a “group practice”.