Photo Credit: Malikov Aleksandr

Physician knowledge of the Scope of Statutes and the Intent Standards for Violations is a vital part of achieving and maintaining a thriving, successful career.

For physicians, knowledge of healthcare statutes is an essential part of achieving and maintaining a thriving, successful career. According to Chicago-based healthcare attorney Christina M. Kuta, JD, knowledge of the Physician Self-Referral Law, known to come as the Stark Law, is crucial for any physician. The Stark law is a “strict liability” statute, meaning that physicians can violate the law without intent to violate it, even if they lack familiarity with the law itself. If a physician violated the Stark Law, consequences include various financial penalties, giving back any payments from Medicare, and inability to take part in federal healthcare programs.

Kuta notes that Civil Monetary Penalties (CMPLs) also come into play with the Stark Law, in situations when a physician Stark-non-compliantly leases a workspace with a physician lessor and refers Medicare patients to the lessor for designated health services. Somewhat contrary to the “strict liability” nature of Stark, the government cannot make physicians pay CMPLs unless it can prove that they acted “knowingly.”

Another law that Kuta asserts is essential for physicians to understand is the Anti-Kickback Statute (AKS), which states that, unless they comply with a certain “safe harbor” stipulation, “renumerations” may not be knowingly given or received in exchange for referrals or any other item payable by a Federal healthcare initiative. Failure to abide by the AKS rules can result in financial penalties, return of Federal-healthcare program payments, CMPLs, and possible jail time.

Physicians who violate Stark and the AKS might experience penalties and legal action under the FCA. As such, Kuta also urges physicians to familiarize themselves with the False Claims Act (FCA), another statute that is not “strict liability” but prohibits physicians from knowingly filing false claims. Physicians who violate FCA regulations might experience serious civil financial penalties, inability to take part in federal healthcare programs, and possible jail time.

 Kuta stresses that understanding the various scopes and rules of violation-intent for each statute is imperative for any physician. Doing so can help physicians to avoid significant financial losses, inability to participate in federal healthcare programs, and possibly even jailtime.