In an article published in the July 2017 issue of the Health Care Compliance Association’s Compliance Today, Scott C. Withrow analyzed the materiality requirements for False Claims Act claims promulgated pursuant to the recent U.S. Supreme Court decision in Escobar as applied to Stark Law claims. The key uptakes are:
» The Stark Law expressly prohibits Medicare from paying claims for designated health services furnished pursuant to physician referrals unless a Stark Law exception applies.
» The Stark Law plays a key role in ensuring that services are reasonable and necessary—and not provided merely to enrich the referring physician.
» Compliance with the “writing” requirement permits a reviewer to determine whether a financial arrangement is based on the volume or value of physician referrals.
» Compliance professionals should obtain reputable third-party valuations of physician compensation arrangements to document and support compliance with the Stark Law’s fair market value requirement.
» Compliance professionals should ensure variable physician compensation is limited to personally performed services or satisfies the compensation rules for a Stark-compliant physician group practice.
Please click here for the full article as published in HCCA’s Compliance Today.