Physicians and employees of doctors' offices can face investigations, financial penalties, and even criminal charges if they do not keep track of the many laws designed to prevent fraud and corruption in the medical profession. You should keep meticulous records of insurance claims, billing, referrals, and treatments. These days, no one can survive on a salary alone, not even physicians, so you must be cautious that any outside work that you do does not create a conflict of interest with your main employment. Regulators scrutinize doctors' offices and companies that provide equipment and services to patients to make sure that they are not diverting funds meant for patient care in order to enrich themselves. Therefore, an honest mistake or an insurance claim for a medically necessary service can raise flags and lead to an extensive investigation of your workplace and your finances.
If your workplace is under investigation for alleged violations of the Stark Law or other laws governing payment for medical services, contact a Texas white-collar crime lawyer.
Provisions of the Stark Law
Except when treating patients for the simplest medical complaints, doctors must often refer patients to specialists or order medical devices for them. This system of referrals has functioned as a vehicle for kickback schemes and other fraudulent dealings in many criminal cases involving healthcare fraud, as well as in many whistleblower complaints. The Stark Law sets specific prohibitions against physicians acting in self-interest when making referrals. This federal law, which came into effect in 1990, takes its name from Pete Stark, the Congressman who wrote the original version of the law. It forbids physicians from ordering "designated health services" for patients from entities in which the physician or a close family member of the physician has a financial interest.
The following are examples of designated health services:
● Radiology services, such as X-rays, MRIs, or ultrasound imaging
● Laboratory testing
● Medical devices or durable medical equipment, such as wheelchairs, walkers, crutches, or TENS units
● Physical therapy or occupational therapy
● The equipment and formula required for enteral or parenteral nutrition
A financial conflict of interest is present when the physician or the physician's family member is an owner or investor in the company or has made an arrangement to receive compensation when the company provides designated health services.
Can You Get Criminal Penalties for Stark Law Violations?
Most Stark Law violations only result in civil penalties, but these are bad enough because the fines can be costly, and you could get a medical license suspension. Even if your license doesn't get suspended, the Stark Law violation could harm your professional reputation. In some cases, doctors and employees of doctors' offices receive criminal charges for healthcare fraud arising from Stark Law violations, especially if they attempted to mislead investigators or conceal evidence. If you are under investigation about referrals for designated healthcare services, the best thing you can do to avoid making things worse is to hire a criminal defense lawyer.
Contact the Law Office of Patrick J. McLain, PLLC About Criminal Defense Cases
A Dallas criminal defense lawyer can help you if you are facing legal trouble because of an alleged Stark Law violation. Contact the Law Office of Patrick J. McLain, PLLC, in Dallas, Texas, to discuss your case.