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September 2007 MEMBER BRIEFING FRAUD AND ABUSE, SELFREFERRALS, AND FALSE CLAIMS HOSPITALS AND HEALTH SYSTEMS PHYSICIAN ORGANIZATIONS AND REGULATION, ACCREDITATION, AND PAYMENT PRACTICE GROUPS STARK.

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Period of Disallowance: The "period of disallowance" is the period of time during which a physician may not make referrals for designated health services to an entity and the entity may not bill Medicare for the referred designated health services due to a Stark violation.

Commercially Reasonable – Many Stark exceptions require payment to be “commercially reasonable” even when referrals are made between physician and health care entity. Under Stark, payment and services must both be commercially reasonable.

The personal services exception is one of the most widely utilized Stark Law Exception. Specifically, this exception is typically utilized when a health system contracts with an individual physician as an independent contractor or with an entire group.

The final rulemaking identifies exceptions based upon three levels of risk: value-based arrangements with full financial risk; value-based arrangements with meaningful downside financial risk; or any value-based arrangement, without regard to the level of risk, provided specified requirements are met.

Certain outpatient prescription drugs identified on HCFA's website (updated annually) that are EPO and other dialysis-related drugs and are administered in or by an ESRD facility are exceptions to the Stark law prohibition.

Among these revisions are allowing indefinite holdovers in two notable exceptions to the Stark law: (1) personal services arrangements and (2) rental (i.e., leases) of equipment and office space. Such “holdover” allowances had previously been limited to six (6) months by regulation.

Four exceptions currently permit these types of arrangements: the office space exception, the equipment lease exception, the fair market value exception and the indirect compensation arrangement exception.

Under Stark III, an independent contractor physician must furnish patient care services for the group prac- tice under a direct contractual arrangement with the group, and not between the group practice and another entity, such as staffing entity.

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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232