I am concerned that I may be violating Stark issues because of some materials I read in another forum. I provide my patients with DME, such as AFO and foot orthotics and other Designated Health Services, such as Xrays, MRI etc.. What should I do to make sure I am compliant and not in violation of Stark Rules.
Great questions. Stark rules apply primarily to Medicare patients and to Designated Health Services (DHS). Some DHS are DME some are not. Examples of DME DHS are Orthotics (including foot) and prosthetics. Examples of DME which are not DHS are surgical dressings. DHS have certain limitations which do not apply to other DME services and non DME services.
Examples of non DME DHS provided by physicians are radiology imaging services (e.g. x-rays, MRI etc.) and physical therapy.
Now that you know what Stark applies to let’s briefly explain what it is.
Stark was developed to preclude referrals of your patients to entities to which you have ownership in. An MRI center, physical therapy center or orthotic laboratory which are not in your office would be perfect examples. Essentially Stark is there to preclude you from referring a patient to another entity from which you could derive additional profit.
Stark laws are quite complicated but it is fair to say that if you yourself are providing orthotic services in your office, you are exempt from the Stark limitations. If you employ an orthotist in your office an h/she is on your payroll and you are the billing entity, that too should be fine. But if the orthotist is paying you a per patient fee for each orthotic they make, that could be problematic.
Due to recent changes in how medical services are delivered, especially with private equity and hospitals taking over private practices, the Stark laws have been pushed to their limits. Many groups feel many Stark laws are obsolete and are lobbying to add more exemptions.
The best suggestion to make sure you are compliant with Stark, is to speak with a health care attorney who is well versed in the Stark and Antikickback regulations.
