PHYSICIAN SELF REFERRAL Meaning and
Definition
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Physician self-referral, also known as the Stark Law or the Stark II Law, refers to a specific type of referral arrangement in the healthcare industry. This term relates to situations where a healthcare provider (typically a physician) refers their patients to receive designated health services (DHS) to an entity with which they have a financial relationship.
Under physician self-referral arrangements, the referring physician has a financial interest in the entity that provides the designated health services. This can involve ownership, investment, or compensation agreements with the entity. The intent behind physician self-referral laws is to prevent financial incentives from influencing physicians' decisions, ensuring that patient care is prioritized above financial gain.
This practice is heavily regulated by numerous statutes and regulations, including the federal Stark Law and the Anti-Kickback Statute. The Stark Law specifically prohibits physicians from referring Medicare patients for certain designated health services to entities in which they hold a financial interest, unless certain exceptions apply. Violations of physician self-referral laws can result in severe penalties, including substantial fines, exclusion from Medicare, and even potential criminal charges.
Physician self-referral laws are ultimately aimed at promoting transparency, maintaining the integrity of the healthcare system, and preventing potential conflicts of interest that may compromise patient care. These regulations strive to ensure that patients receive appropriate and unbiased referrals that are solely based on their best interests and medical needs, rather than financial considerations for the referring physician.
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