Content area
Full Text
Senator Pete Stark, sponsor of the Physician Self-Referral Law, was recently quoted as saying he wished he had never sponsored the law due to its now complex requirements and iterations imposed by the Centers for Medicare & Medicaid Services. The new Stark II Phase III rules further muddy the waters. This article reviews the basic Stark prohibitions and provides an overview of Stark II Phase III.
Key words: Stark; self referral; Stark III; Phase III; Physician Fee Schedule.
On September 5, 2007, the Centers for Medicare & Medicaid Services (CMS) published the long-awaited third installment in its rulemaking process under the federal physician s elf- referral prohibition commonly known as the "Stark law." Stark II Phase III (Stark III) is the final phase of the CMS rulemaking process related to the Stark law. AU parts of the new regulations were to be effective December 4, 2007. However, on November 15, 2007, CMS delayed the effective date of the so-called "stand in the shoes" provisions of Stark III for academic medical centers and nonprofit integrated health systems until December 4, 2008. AU other provisions of the regulations became effective December 4, 2007.
While CMS states that the purpose of the Stark III rules is to reduce the regulatory burden on the healthcare industry through CMS' interpretation and modification of previously promulgated exceptions to the Stark Law's general prohibition on referrals, Stark continues to be one of the most complex and confusing laws impacting medical groups. Experienced healthcare attorneys and government regulators continuously debate the meaning of Stark, and no healthcare provider should contemplate any arrangement potentially implicating Stark without the guidance of knowledgeable legal counsel. Further complicating the new Stark III rules are the 2008 Physician Fee Schedule revisions related to the physician self- referral rules.
STARK BASICS
The original Stark self- referral prohibition was enacted in 1989 with the purpose of prohibiting physicians from referring patients for laboratory services to entities in which the physicians had a financial interest. The selfreferral ban was referred to as "Stark I" after Rep. Pete Stark (D-CA), who introduced the legislation. In 1993, Stark was expanded to cover additional healthcare services considered to be particularly susceptible to overutilization as a result of physician financial interests and to apply...