In today’s complicated world of healthcare, individual practitioners as well as large hospitals must keep informed of ever-changing rules and regulations on the state and federal levels. One of the most important areas to stay well informed on involves fraud and abuse, which can carry severe penalties and be career-ending in some cases. In addition, healthcare practitioners are also attempting to run their offices and hospitals based on proven business principles that have worked well in the past. However, as many in healthcare have found out the hard way, in many instances it is far too easy to violate a regulation and not realize it until the damage has already been done. When expert guidance is needed regarding such topics as the Stark Law, Anti-Kickback laws, and fraud and abuse of Medicare and Medicaid rules, we here at Potashnik and Associates have the experience and knowledge to handle the most difficult of cases.

Stark Law

While this law often sounds as if virtually everyone in healthcare may be in violation, the truth is it is a complex yet rather easy law to navigate if you have the correct legal guidance. With our more than 25 years of healthcare law experience, Potashnik and Associates knows all too well the many pitfalls that await organizations that are lax in regards to the Stark Law. One of the most important functions we offer as a firm is working closely with entrepreneurial health care practices to analyze such things as notice requirements, Medicare conditions of participation, billing rules, fee-splitting prohibitions, and more as they pertain to the Stark Law. We specialize in regulatory analysis for individual and group practices, hospitals, diagnostic testing facilities, physician organizations, equipment leasing companies, and much more. At Potashnik and Associates, we understand how rules and regulations pertaining to healthcare change on a frequent basis, making it harder and harder for doctors to stay up-to-date on the specifics of the Stark Law. Rather than move forward with plans that may be in direct violation of this law, it makes far more sense to let us perform a regulatory analysis early on so that if any conflicts are found, they can be taken care of well before trouble would ensue.

Physician Self-Referral Prohibition

Since its initial publication in 1995, the physician self-referral prohibition that is more commonly referred to as the Stark Law has gotten much more complex. When first introduced, it only applied to clinical lab services. However, as healthcare has grown, so has the law itself. Now applying to numerous services, it focuses on the financial relationships between the physician and whatever entity is responsible for performing billing for the services provided by the physician. In essence, the law prohibits doctors from referring any designated health services that are payable by Medicare or Medicaid to any entity in which the doctor has a financial relationship. The only way around this is if an exception is met, which rarely happens based on our many years of studying this law and working with various doctors and medical organizations. If no exceptions are met, the penalties for violating the Stark Law can be very severe. Punishments can include a combination of refund of payment, denial of payment, a $15,000 fine per service rendered and a $100,000 penalty for each situation deemed to be an attempted circumvention scheme. Unfortunately, over the years we have seen many physicians endure extremely severe penalties for violation of this law. In most cases the violations were not considered criminal in nature, but were nevertheless violations that had to result in penalties being imposed. We suggest that well before you organize and finalize plans for your practice, contact us and let us examine your plans and billing relationships in great detail to help you avoid any embarrassing and potentially difficult cases that could result in further action being taken against you or your practice.

Put Our Experience to Work for You

Whenever there is any question about billing integrity, it’s vital to work with a legal team that has the experience and knowledge needed to ask the tough questions and get the necessary answers. That’s what we here at Potashnik and Associates do, since we specialize in healthcare law. We can carefully analyze the Stark Law and see if it pertains to your group’s billing practices as well as determine if there are any exceptions you may be able to meet. Our lawyers, considered to be some of the most highly-educated in the nation, are constantly updating their training regarding the Stark Law in order to stay on top of the latest developments. By having us perform an analysis, we can structure contracts accordingly, as well as make recommendations as to how certain policies and procedures should be constructed. To make sure you and your practice are in full compliance with the Stark Law, we recommend letting us perform a yearly analysis since the details of this law are subject to frequent change.

Anti-Kickback Statute

In addition to the Stark Law, the Anti-Kickback statute is also something that must be carefully examined to ensure physicians are not in violation of its standards. For those who are found in violation, criminal penalties can result that will virtually guarantee the shutting down of a practice and the end of a medical career. Penalties can include $25,000 fines, up to five years in prison, exclusion from the Medicare program, or a combination of these. The statute, which focuses on those who willfully offer, pay, solicit, or receive money in exchange for inducing business that is payable by Medicare or Medicaid, is considered to be one of the most serious offenses that can be committed by medical professionals. Therefore, it is imperative that doctors be keenly aware of how their business relationships can relate to this statute. In order to have the most complete understanding possible regarding this issue, using an experienced firm such as Potashnik and Associates can help ensure no violations are being committed. This is critical since once criminal penalties are imposed, certifications and licensures are also taken away from the physician, effectively ending their ability to practice medicine.

Business Planning

To make sure none of this will apply to your practice, we highly recommend consulting with us during the business planning stages. It is during this time that we can analyze contracts for possible conflicts of interest and other issues, as well as examine the specific rules of corporate practice medicine as they apply to the state in which your practice will be located. In many situations, state-specific rules and regulations regarding Medicare and Medicaid may be in effect, which can create possible conflicts if not known prior to contract development and implementation. When these and other issues are addressed during the business planning stage, the chances of a misunderstanding down the road greatly decrease. We here at Potashnik and Associates are always willing to answer any and all questions you may have on this topic, helping you avoid future problems that could be much bigger that you anticipated. Rather than risk possibly losing your medical license, it’s best to let us help you before finalizing your plans.

Contact Us Today

When you find yourself having questions about the Stark Law or other statutes, it’s imperative that you seek the advice of legal counsel who have the knowledge and experience pertaining to your subject. That’s what we offer at Potashnik and Associates, where our combination of 25 years experience as well as commitment to our clients ensures you will have all of your questions answered in a quick and professional manner. We take each concern of our clients very seriously, which allows us to put ourselves in their situation. By doing so, we are able to gain a much better understanding of how our advice will play a part in helping establish the medical practice. By taking the time to closely examine the situations our clients will face daily, we are then able to draft contracts and other paperwork in ways that virtually guarantee there will be no conflicts of interest for anyone.

To put our knowledge, commitment, and experience to work for you, contact us as soon as possible. You can reach us in a variety of ways, one of which is visiting our website at www.healthcarelawassociates.com and filling out our online contact form. This is often the fastest way, since the information will go directly to one of our attorneys and allow them to look it over before contacting you. Or if you prefer, you can give us a call at 1-212-577-6677 or send an e-mail to jp@jpolawfirm.com. No matter which method you use, we guarantee you will get a fast response to your questions. We will be happy to meet with you at your convenience to discuss your situation, since we realize each person’s situation is unique. When you want and need the best legal counsel available in healthcare law, contact us here at Potashnik and Associates to get your questions answered.