Which law prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest?

Which law prohibits a provider from referring Medicare patients to a clinical laboratory service in which the provider has a financial interest?

• A. Stark Law
• B. Anti-Kickback Statute
• C. False Claims Act
• D. Health Care Fraud Statute

Answer: (A)

Stark Law prohibits physician self-referral of designated health services, such as clinical laboratory services, to an entity with which the physician has a financial relationship. If a provider owns or has a financial arrangement with a lab, referring Medicare patients to that lab would typically violate Stark Law unless an applicable exception or safe harbor applies. This is a civil, strict-liability rule that can lead to penalties like denial of payment, refunds, civil monetary penalties, and possible exclusion from programs. While the Anti-Kickback Statute also targets improper referrals, it focuses on kickbacks and payments to induce referrals and generally requires knowledge or intent, making Stark Law the more direct prohibition in this self-referral scenario. False Claims Act and broader health care fraud provisions address submitting or causing false claims, not the specific self-referral restriction at issue here.

Stark Law prohibits physician self-referral of designated health services, such as clinical laboratory services, to an entity with which the physician has a financial relationship. If a provider owns or has a financial arrangement with a lab, referring Medicare patients to that lab would typically violate Stark Law unless an applicable exception or safe harbor applies. This is a civil, strict-liability rule that can lead to penalties like denial of payment, refunds, civil monetary penalties, and possible exclusion from programs. While the Anti-Kickback Statute also targets improper referrals, it focuses on kickbacks and payments to induce referrals and generally requires knowledge or intent, making Stark Law the more direct prohibition in this self-referral scenario. False Claims Act and broader health care fraud provisions address submitting or causing false claims, not the specific self-referral restriction at issue here.