Improve the health of the people of Wisconsin by supporting and strengthening physicians' ability to practice high-quality patient care in a changing environment.

Stark law under review

The U.S. House of Representatives Committee on Ways and Means recently held a hearing reexamining the Stark Law in light of the transition from volume to value in the Medicare Program. The hearing followed a request from the Centers for Medicare and Medicaid Services seeking public input regarding ways to address any undue regulatory burden caused by the law.

Enacted in 1989, the Stark law was created to prevent physicians’ health care decision-making from being influenced by their financial interests. Specifically, it

1) Prohibits a physician from making referrals for certain designated health services payable by Medicare to an entity with which he or she (or an immediate family member) has a financial relationship (ownership or compensation), unless an exception applies.
2) Prohibits the entity from filing claims with Medicare (or billing another individual, entity, or third-party payer) for those referred services.

The Committee heard testimony from Eric Hargan, deputy secretary of the Department of Health and Human Services, Mike Lappin, chief integration officer for AdvocateAuroraHealth and others who cited barriers and burdens caused by the law. They also testified that the current application of the law is deterring and prohibiting innovation, particularly for the Alternative Payment Models being encouraged by CMS, and offered the following potential solutions:

  • Codifying waivers to Stark Law into statute.
  • Effectively eliminating the case-by-case waiver determination by CMS.
  • Revising current anti-kickback statutes, simplifying the law to recognize the proliferation of value-based payment and alternative models of care.
  • Removing “volume or value” wording from Stark Law prohibitions.

The Society will continue to monitor this issue and work toward reducing physician burden. Contact HJ Waukau or Lisa Davidson with questions.

Back to July 26, 2018 Medigram