If you have evidence that a physician is violating the self-referral law of the False Claims Act, you could become a Stark Law whistleblower. The Physician Self-Referral law, also known as the Stark Law, restricts physicians from making referrals for designated health services that will be paid for by Medicaid or Medicare if the physician has a financial relationship with the entity to which he is referring the patient.
The circumstances under which a physician would violate this law are very specific. Therefore, let’s break it down further to clarify exactly when a physician is breaking the Stark Law:
The Referral Is for a Designated Health Service.
The Stark Law only applies to very specific diagnostic tests and certain procedures, classified as designated health services, or DHS. As a result, DHS includes any of the following tests or procedures:
- Laboratory services
- Physical, occupational, and outpatient speech-language therapy
- Certain imaging services, including radiology
- Services and supplies pertaining to radiation
- DME and associated supplies
- Parenteral and enteral nutrients and associated equipment and supplies
- Prosthetics, orthotics, and any associated devices or supplies
- Home health services
- Prescription drug obtained on an outpatient status
- Finally, inpatient and outpatient hospital services
Medicaid or Medicare Pay for the Designated Health Service.
This law aims to prevent the occurrence of Medicaid or Medicare fraud. Therefore, the law only applies to services that Medicaid or Medicare reimburse.
The Physician Has a Financial Relationship with the Entity.
This is the self-referral portion of the law. If the physician making the referral, or a family member, invests in, owns, or will be compensated for the referral in some way, this is considered a financial relationship. Furthermore, the Stark Law prohibits physicians from referring the services listed above to an entity with which they have a financial relationship.
Do I Need a Lawyer If I am a Stark Law Whistleblower?
The answer to this question is, it depends. If you wish to use a hotline to file a complaint, you are free to do so. However, it is important to understand you cannot receive a reward as a Stark Law whistleblower when you use a hotline. The False Claims Act indicates that Stark Law whistleblower may be able to receive a portion of the recovered funds. Hence, you must file your claim with an attorney if you wish to receive the reward.
The team at Bothwell Law Group has extensive experience navigating the Stark Law and assisting Stark Law whistleblowers in obtaining the compensation they deserve for reporting fraud. Therefore, you can learn more about becoming a Stark Law whistleblower, call 770.643.1606 to speak with one of the experienced attorneys at Bothwell Law Group.