June 2018 – On June 19, 2018, the Centers for Medicare & Medicaid Services (“CMS”) issued a Request for Information (“RFI”) seeking public input on how to address any undue impact and burden of the physician self-referral law, 42 U.S.C. § 1395nn (the “Stark Law”).
By way of background, the Stark Law addresses the concern that health care decision making can be unduly influenced by a profit motive and when physicians have a financial incentive to refer patients for health care services, overutilization in medical services may result. To counter such concerns, the Stark Law, subject to certain exceptions: (1) prohibits physicians from making referrals for certain designated health services (“DHS”) payable by Medicare to an entity with which the physician (or an immediate family member) has a financial relationship; and (2) prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third-party payer) for those referred services.
In response to a prior RFI published by CMS requesting comments on improvements that can be made to the health care delivery system that reduce unnecessary burdens, the commenters identified compliance with the Stark Law and its regulations as one of the top areas of burden. In response to these concerns, CMS is now requesting additional information. Specifically, CMS is interested in thoughts on issues that include the structure of arrangements between parties that participate in alternative payment models or other novel financial arrangements, the need for revisions or additions to exceptions to the Stark Law and terminology related to alternative payment models and the Stark Law.