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Common Legal Questions

HIPAA Notice


Common Legal Questions

1. Is this arrangement in violation of Stark?

No. The Stark Law prohibits a physician from referring Medicare or Medicaid patients to an entity for the provision of designated health services if the physician or an immediate family member has a financial relationship with that entity, unless a particular transaction qualifies under a defined Stark exception.

One exception is for "In-Office Ancillary Services," which specifically excepts services provided and billed through a physician's office as long as certain definitions are met. In the IDC model, the physician leases the space, equipment and personnel in order to provide and bill for those services performed.

Adherence to a Stark exception is not necessary if a physician chooses not to provide Designated Health Services to Medicare or Medicaid patients within his/her leased facility. Also, IDC constantly monitor changes in pending regulations, to advise our participating physicians accordingly.

2. Does this arrangement violate Anti-Kickback Law?

No. Essentially, the Anti-Kickback Law prohibits the payment or receipt of renumeration in exchange for a current or potential referral of Medicare, Medicaid or other government program patients.

To provide some guidance to the healthcare industry, the Office of Inspector General (OIG) publicized final Safe Harbor regulations that specify payment practices that will NOT be considered to violate the Anti-Kickback Law. If an arrangement falls within one of the final Safe Harbors, the person or entity involved in the payment practice will be immune from criminal prosecution and civil exclusion for violation of the Anti-Kickback Law. IDC lease agreements are structured to fit within the "Space Rental," "Equipment Rental," and "Personal Services and Management Contracts" Safe Harbors.