©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
HCCA CHC - Stark & Anti Kickback Study
Guide with Complete Solutions
AntiKickback Statute Highlights - Answer✔️✔️-1. Criminal/Civil (you go
out of business
2. Any federal health program (Medicare, Medicaid, Tri-Care)
3. Requires proof of improper intent (DOJ-Criminal)
4. Applies to any referral source
5. 24 Safe Harbors
6. OIG Advisory Opinions
Stark Highlights - Answer✔️✔️-1. Civil only (no prison time)
2. Medicare only
3. Strict Liability (does not consider knowledge or intent. if X happens, then
you are held liable regardless of intent.)
4. Must be a physician and entity in the mix
5. Exceptions
6. CMS Advisory Opinions
Stark Law Enforcement - Answer✔️✔️-1. CMS
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
2. HHS-OIG (Does not enforce, but reviews Stark Violations to see if there
is a kickback)
3. DOJ (only enforces false claims act, predicated on Stark/Tainted
Referral)
Stark Law 42 USC 1395nn - Answer✔️✔️-Non-compliance period is known
as the 'disallowance period." No billing of Medicare or patient during
disallowance period/non-compliance period. Any co-pays during this time
also need to be returned.
After discovering Stark Law non-compliance... - Answer✔️✔️-put a bill-hold
immediately.
Stark prohibits - Answer✔️✔️-A physician from making a referral of a
Medicare Patient to an entity that furnishes 'designated health services'
(DHS) if the physician has a financial relationship with the entity, unless an
except applies.
What are Designated Health Services (DHS)? - Answer✔️✔️-CMS list of
HCPCS codes. For hospitals, it includes EVERYTHING because HCPCS
code of inpatient/outpatient referrals.
Stark 3-step analysis - Answer✔️✔️-1. Is there a referral from a physician for
a DHS?
2. Does the physician (or immediate family member) have a financial
relationship with the entity providing the DHCS?
2
HCCA CHC - Stark & Anti Kickback Study
Guide with Complete Solutions
AntiKickback Statute Highlights - Answer✔️✔️-1. Criminal/Civil (you go
out of business
2. Any federal health program (Medicare, Medicaid, Tri-Care)
3. Requires proof of improper intent (DOJ-Criminal)
4. Applies to any referral source
5. 24 Safe Harbors
6. OIG Advisory Opinions
Stark Highlights - Answer✔️✔️-1. Civil only (no prison time)
2. Medicare only
3. Strict Liability (does not consider knowledge or intent. if X happens, then
you are held liable regardless of intent.)
4. Must be a physician and entity in the mix
5. Exceptions
6. CMS Advisory Opinions
Stark Law Enforcement - Answer✔️✔️-1. CMS
1
, ©SOPHIABENNET@2024-2025 Thursday, August 22, 2024 10:21 AM
2. HHS-OIG (Does not enforce, but reviews Stark Violations to see if there
is a kickback)
3. DOJ (only enforces false claims act, predicated on Stark/Tainted
Referral)
Stark Law 42 USC 1395nn - Answer✔️✔️-Non-compliance period is known
as the 'disallowance period." No billing of Medicare or patient during
disallowance period/non-compliance period. Any co-pays during this time
also need to be returned.
After discovering Stark Law non-compliance... - Answer✔️✔️-put a bill-hold
immediately.
Stark prohibits - Answer✔️✔️-A physician from making a referral of a
Medicare Patient to an entity that furnishes 'designated health services'
(DHS) if the physician has a financial relationship with the entity, unless an
except applies.
What are Designated Health Services (DHS)? - Answer✔️✔️-CMS list of
HCPCS codes. For hospitals, it includes EVERYTHING because HCPCS
code of inpatient/outpatient referrals.
Stark 3-step analysis - Answer✔️✔️-1. Is there a referral from a physician for
a DHS?
2. Does the physician (or immediate family member) have a financial
relationship with the entity providing the DHCS?
2
