Stark Law for private-practice physicians

The law applies to referrals for designated health services, which include clinical laboratory work, physical and occupational therapy, radiology and imaging, radiation therapy, durable medical equipment, home health, outpatient prescription drugs, and hospital services. A financial relationship includes ownership, investment and any compensation arrangement, whether it runs directly or through another entity.

• Bonuses, profit shares or productivity pay calculated in a way that reflects the value or volume of a physician's referrals.
• In-office imaging, lab or therapy services set up without meeting the location, supervision and billing requirements of the in-office ancillary services exception.
• Office leases and service agreements with no signed agreement, an expired term, or rent and fees outside fair market value.
• Medical directorships and consulting roles paid for work that is not documented or not needed.
• Arrangements with a physician's immediate family members, which count the same as the physician's own.

Payments received for services referred under a noncompliant arrangement must be refunded regardless of intent. Where a party knew or should have known, civil monetary penalties apply per service, and violations can also support False Claims Act liability and exclusion from federal health programs. Because the law turns on technical requirements, a paperwork gap such as an expired lease can create repayment exposure on its own.

• Review existing compensation plans, leases, and service and directorship agreements against the exceptions they rely on.
• Structure new arrangements, including in-office ancillary services, before they start.
• Close gaps such as missing signatures, expired terms and fair market value questions, and advise on next steps when a problem has already occurred.
• Address the Anti-Kickback Statute and California's own self-referral law, which apply alongside Stark.