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Get integrated but don’t…

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We’re going to see a lot more Stark Law cases as physicians and physician groups are pressed to get more integrated with hospitals. There’s a bit of a paradox here:  CMS and some other government agencies are pressing for more care integration even as the Stark Law can discourage it.

So, reports Modern Healthcare, we have a California hospital, Tri-City Medical Center, in Oceanside,  “agreeing to pay $3.28 million to settle allegations that nearly 100 of its payment arrangements with doctors and physicians groups broke federal law. The hospital self-reported the potential violation.”

As the publication nicely summarizes: “The Stark law prohibits doctors from referring Medicare patients to hospitals, labs and other doctors that the physicians have financial relationships with unless they fall under certain exceptions. Those exceptions require that the financial arrangements between hospitals and doctors be commercially reasonable and not take into account the number of a doctor’s referrals to the hospital.”

To say the least, trying to comply with the Stark Law can be a challenge, including figuring out what “commercially reasonable” means.



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