STARK Flashcards
(STARK) Stark Violation Can be For…
- P making non-compliant referrals; or2. E presenting or causing to be presented claims to Medicare/Medicaid from non-compliant referrals
(STARK) Stark Citations
Statute: 42 USC 1395nnRegs: 42 CFR 411.350
(STARK) Stark Step Analysis
1) Is a P or immediate family member of P involved?2) Does P make a referral to an entity?3) Does referral involve M/M Services?4) Does referral involve DHS Services?5) Does referring P and entity have financial relationship?6) Is there an exception?
(STARK) Physicians (Definition)
- MD2. DO3. Dentist4. Podiatrist5. Optometrist 6. Chiropractor
(STARK) Immediate Family Member (Definition)
- Husband/Wife2. Birth/Adoptive Parent3. Child4. Sibling5. Stepparent6. Stepchild7. Stepsibling8. Parent-in law9. Child in law10. Grandparent11. Grandchild12. Spouse of GParent/GChild
(STARK) Entity (Definition)
A Physician’s sole practice or a practice of multiple Physicians, or any other person, sole proprietorship, public or private agency or trust, corporation, partnership, LLC, foundation, Nonprofit Corp, or unincorporated association, that furnishes DHS.
(STARK) Referral (Definition)
-A request, order, or certification-The establishment of a plan of care
(STARK) Conduct that Stark Explicitly Excludes as Referral
1) DHS personally performed or provided by P2) a) A Request by a Pathologist for Clinical Lab Tests and pathological examination services, b) A Request by a radiologist for diagnostic rads services, or c) A Request by a rads onc for rads therapy or ancillary services necessary for, and integral to, the provision of rads therapy, if 1) The request results from a consultation initiated by another P; and 2) The tests or services are furnished by or under the supervision of the pathologist, rads onc, or under supervision of pathologist, rad, or rads onc, respectively in the same GP as the pathologist, rad, or rads onc
(STARK) Designated Health Service
1) Clinical Lab Services;2) Physical Therapy, Occupational Therapy, and Outpatient speech-language pathology services;3) Radiology & certain other imaging services (except for a few exceptions);4) Radiation Therapy Services & Supplies5) DME and Supplies6) Parenteral and Enteral Nutrients, Equipment, and Supplies7) Prosthetics, orthotics, and prosthetic devices and supplies; 8) HHS;9) Outpatient Prescription Drugs; and10) Inpatient & Outpatient Hospital Services.
(STARK) Types of Financial Relationships
1) Direct Ownership Interest2) Indirect Ownership Interest3) Direct Compensation4) Indirect Compensation
(STARK) Direct Financial Relationship (Definition)
1) Compensation Relationship; or 2) Ownership/Investment Interest
(STARK) Indirect Financial Relationship- Compensation (Definition)
1) Unbroken Chain (Either Compensation or Investment Interests);2) Compensation relationship closest to Physician take into account the value or volume of referrals to DHS Entity;3) Does DHS Entity have knowledge of above?4) Stand In the Shoes Exception?
(STARK) Stand In the Shoes (SITS) Exception
Exception to Indirect Financial Compensation Relationship (Element of Stark Analysis): Provides that a Physician with and Ownership or Investment Interest in a Practice “Stands in the Shoes” of the Practice for this determination.
(STARK) Ownership Interest (General Definition)
-May be through equity, debt or other means-Includes an interest in an entity that holds an ownership interest in any entity providing the DHS.
(STARK) Compensation Arrangement (General Definition)
-Any arrangement involving any remuneration bw a P and an and an entity. Remuneration defined as “any remuneration, directly or indirectly, overtly or covertly, in cash or in kind.”
