Stark law: RESPONSES
Randy McFarland
Description
Collection
Title:
Stark law: RESPONSES
Creator:
Randy McFarland
Date:
8/1/2003
Text:
ORIGINAL QUESTION:
Has anyone heard if there have been any recent change to the Stark
laws? (The laws that deal with physicians referring to entities in which
they have a financial stake). I spoke with a DME rep. who heard this
rumor, but we don't know if there's anything to it.
We have a local physician group that has created their own separate
DME corporation and they're billing for cam walkers, post op KOs and
corsets. Not that I plan to raise the issue with them, but the
applicability of the law may impact the duration of their strategy.
Randy McFarland, CPO
Fullerton, CA
From the info I've seen it seems that a doctor isn't allowed to refer to
another entity in which they or a relative have a financial stake. There
seems to be permissible for them to do fittings in-house.
RESPONSES:
I have heard mention of changes in the perception of the law in relation
to the care given by physician as being more appropriate that they
provide DME rather than O&P.I know of quite a few physicians that
include providing CAM walkers,night splints,prefab AFOs,and just about
anything SPS will sell them.I have to compete with all the sale reps in
the area setting them up to do their own custom knee braces.We don't
have licensure in LA but,I don't think it would do any good.I try to
keep my mouth shut and let the physicians anPTS build their wonderful
contraptions and hope that those patients will eventually make it my way
to be taken care of properly.If you hear of any actual change in the law
please list it.
There are restrictions such as where the doctors see their patients, how
profits are divided up etc. but these physicians can legally bill for
their own patients. They probably cannot bill for DME for other
patients however.
I asked one of our doctors here and there is a stark law which states
the doctor can't refer patient to a place which they own or take money
from for their referrals.
Look at this link of overview of the stark law. I states in first
section under Stark Law prohibition what you are referring to.
<URL Redacted>
According to Stark II there are 11 or 12 designated health services that
a physician can not be financially involved in and refer to himself.
Physical Therapy, Occupational Therapy, and Prosthetic and Orthotics are
a few of these designated health services.
This does not stop a physician from applying a brace and being paid
for it or applying therapy to a patient and being paid for it. As long
as the physician is providing the services himself then he may be
reimbursed for the services. On the other hand if he owns (in part or
in full) a O & P shop and sends the work to them, then he is violating
the Stark II laws.
The problem is that there is a law on the books with no true
authorities to enforce it.
I am no expert, but have been told of a modification to the Stark law
that allows physicians to have such ancillary services as long as they
are on site. I was told this by a physicians office manager who is
attempting to negotiate something with me. I brought up the Stark law
and she told me of its dilution. They already have a PT in an adjacent
office. So, I do not know how true it is. But this woman made it
clear that their lawyer thought it was true.
We are dealing with Dr owned O & P . They call it onsite services like
blood work and prescribe outrageously.
Has anyone heard if there have been any recent change to the Stark
laws? (The laws that deal with physicians referring to entities in which
they have a financial stake). I spoke with a DME rep. who heard this
rumor, but we don't know if there's anything to it.
We have a local physician group that has created their own separate
DME corporation and they're billing for cam walkers, post op KOs and
corsets. Not that I plan to raise the issue with them, but the
applicability of the law may impact the duration of their strategy.
Randy McFarland, CPO
Fullerton, CA
From the info I've seen it seems that a doctor isn't allowed to refer to
another entity in which they or a relative have a financial stake. There
seems to be permissible for them to do fittings in-house.
RESPONSES:
I have heard mention of changes in the perception of the law in relation
to the care given by physician as being more appropriate that they
provide DME rather than O&P.I know of quite a few physicians that
include providing CAM walkers,night splints,prefab AFOs,and just about
anything SPS will sell them.I have to compete with all the sale reps in
the area setting them up to do their own custom knee braces.We don't
have licensure in LA but,I don't think it would do any good.I try to
keep my mouth shut and let the physicians anPTS build their wonderful
contraptions and hope that those patients will eventually make it my way
to be taken care of properly.If you hear of any actual change in the law
please list it.
There are restrictions such as where the doctors see their patients, how
profits are divided up etc. but these physicians can legally bill for
their own patients. They probably cannot bill for DME for other
patients however.
I asked one of our doctors here and there is a stark law which states
the doctor can't refer patient to a place which they own or take money
from for their referrals.
Look at this link of overview of the stark law. I states in first
section under Stark Law prohibition what you are referring to.
<URL Redacted>
According to Stark II there are 11 or 12 designated health services that
a physician can not be financially involved in and refer to himself.
Physical Therapy, Occupational Therapy, and Prosthetic and Orthotics are
a few of these designated health services.
This does not stop a physician from applying a brace and being paid
for it or applying therapy to a patient and being paid for it. As long
as the physician is providing the services himself then he may be
reimbursed for the services. On the other hand if he owns (in part or
in full) a O & P shop and sends the work to them, then he is violating
the Stark II laws.
The problem is that there is a law on the books with no true
authorities to enforce it.
I am no expert, but have been told of a modification to the Stark law
that allows physicians to have such ancillary services as long as they
are on site. I was told this by a physicians office manager who is
attempting to negotiate something with me. I brought up the Stark law
and she told me of its dilution. They already have a PT in an adjacent
office. So, I do not know how true it is. But this woman made it
clear that their lawyer thought it was true.
We are dealing with Dr owned O & P . They call it onsite services like
blood work and prescribe outrageously.
Citation
Randy McFarland, “Stark law: RESPONSES,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/221638.
