Elements Of The Stark Laws

Also referred to as the physician self-referral law, the Stark Law is a set of federal laws enacted as part of the Social Security Act (Dresevic & Mikel, 2015). Accordingly, this law prohibits healthcare practitioners from making referrals, specifically for Medicaid or Medicare patients, to organizations or medical institutions with which the said medical practitioner has a financial relationship. Notably, this financial relationship can be in the form of an investment, ownership, debt, or compensation arrangement between the entity and the medical practitioner or their immediate family member. These referrals apply to designated health services (DHS). The services considered as DHS consist of medical laboratory services, physical therapy and outpatient speech-language pathology amenities, radiation therapy services and supplies, radiology and specific imaging services, occupational therapy amenities, parenteral and enteral nutrients, apparatus and supplies, and durable medical apparatus and supplies (Huttinger & Aeddula, 2022). This is in addition to home health services, outpatient and inpatient hospital services, outpatient prescription medications, prosthetics, orthotics, and prosthetic tools and provisions.

The main purpose of this law is to prevent medical practitioners from making unnecessary referrals in cases where said practitioners have conflicting financial interests. As such, the public, particularly those under Medicare and Medicaid, are protected from practitioners who would overprescribe unnecessary healthcare services for their own financial gain (Huttinger & Aeddula, 2022). However, there are a few exceptions to the Stark Law, including patients who do not use Medicare, if the referral is to an academic medical institution, and for clinical laboratory services, for example, vaccinations. Further exceptions include referrals for in-office ancillary services, for example, wheelchairs, and, last yet most importantly, for general practitioner services, whereby both general practitioners belong in the same group practice. These exceptions only improve the quality of health care for the patient and reduce waste. Further, they promote coordination among medical practitioners and other healthcare service providers, a practice that only benefits patients across the spectrum.

In conclusion, after learning more about the Stark Law, I believe it effectively prevents unethical behavior. Many medical practitioners are connected to medical institutions in one way or another, and therefore, the possibility of fraudulent behavior occurring through referrals between different financially connected practitioners is highly likely. The Stark Laws prevent this kind of behavior, thereby getting quality care and only the necessary services.