Stark Law Questoin

[Czech777]

My family owns a private business that sells DME. I’m a medical resident in a related specialty. There are non-MD/DO practitioners that work there and rely on MD/DO referrals. I would like to work with or for the company. My understanding is that any DME prescription I write cannot be filled at the company due to Stark laws. Is this true? Could I co-sign on NP / PAs that do not violate the stark laws?

Could I work there in the inverse capacity? I.e. the patients that visit the office can see me for all medical concerns relating to their condition (without stepping on their PCP / referring physicians’ toes). Can I bill as an office visit for this?

Are there any other models that allow me to work with the business? How could I best serve my family's business?

Chief medical officer, insurance liaison, etc?

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[QueenJames]

What's a DME?

 

[Czech777]

What's a DME?

Durable Medical Equipment

 

[AliBabaMD]

Best way around Stark is a good healthcare Stark attorney.

As a healthcare exec and MD with experience on the subject, my advice would be to steer clear of DME as long as it is your family business. If you owned the DME business and it was an extension of your practice, you can provide a choice to patients who can decide for themselves what to choose. That can work, not the way you described presently.

AB

 

[Czech777]

I will be an owner. It will be an extension of my practice. So I could write the referral and if (on their own choice) they come to my business, that is not a violation?

 

[AliBabaMD]

It depends on your state as well. In short (from online advice I garnered):

The single most important exception is probably the “in-office ancillary exception” because it protects both ownership and compensation. Often referred to as the “group practice exception,” it is what allows physicians to own imaging, lab and other ancillaries in an urban area.

Basically, the exception says that Stark doesn’t apply to designated health services in the office if you meet the conditions Stark establishes for a “group practice,” including not dividing revenue based on referrals, having 75% of all of the services provided by group physicians billed by the group, etc.

 

[AliBabaMD]

The above is from David Glaser, JD

 

[Tigerhawk77]

Thanks. I was also thinking about other ways to help them. Documentation seems to be a big problem. They get referrals but poor documentation that ultimately leads to payment refusal. I was thinking that an outside provider could provide referral but I eval patient and provide great documentation to make sure they get the service / DME they need. Is that a more realistic goal?