Medicare/Medicaid Fraud & Abuse
Index
Bulletins and Publications on Stark and Anti-Kickback
CMS's Disclosure of Financial Relationships Report
Stark Anti-Referral Laws and Regulations
Anti-Kickback Statutes and Regulations
Comparison Chart of Stark Exceptions and Anti-Kickback Safe Harbors
Related Resources
Set forth below are the statutes, regulations, and other documentation regarding Medicare and Medicaid fraud and abuse. Information includes the Stark anti-referral requirements and general anti-kickback information.
Bulletins and Publications on Stark and Anti-Kickback
CMS Clarifies Lithotripsy “Under Arrangements” Contracts: Can Continue to Use Per-Click and Percentage-Based Payments
February 2009
The Centers for Medicare and Medicaid Services has issued a clarification of the Stark law and hospital "under arrangements" contracts for lithotripsy services.
Major Changes to Stark Law in 2009 IPPS Regulations
August 2008
Bulletin discussing significant changes to the Stark law as contained in the 2009 inpatient prospective payment system regulations.
The Stark Anti-Referral Laws and Regulations
The Stark Statute 42 U.S.C. 1395nn
Note that certain statutory changes were made to the Stark laws in the Patient Protection and Affordable Care Act. Read about the changes here.
Phase I of the Stark II regulations as published in the Federal Register
on January 4, 2001. The regulations constitute final rules and became effective
on January 4, 2002. (Note that section 424.22(d) which deals with home health
certification and plans of treatment is effective February 5, 2001.) Part One
and Two below are 50 pages long and Part Three is 11 pages; all are in pdf.
format.
Part
One
Part
Two
Part
Three
Phase II of the Stark II regulations as published in the Federal Register
on March 26, 2004. The regulations constitute final rules and became effective
on July 26, 2004.
Phase II Regulations
As published in the Federal Register March 26, 2004
Are You Ready to Comply With Stark?
March 2004 Bricker & Eckler bulletin on the Phase II regulations
Phase III of the Stark II regulations as published in the Federal Register
on September 5, 2007. The regulations constitute final rules and became effective
on December 4, 2007.
Phase III Regulations
As published in the Federal Register September 5, 2007
CMS Issues Phase III Stark Regulations
August 2007 Bricker & Eckler Bulletin on the Phase III Regulations
The complete Stark regulations section by section,
including the Phase III amendments
-
411.350 Scope
-
411.351
Definitions
-
411.352
Group Practice
-
411.353
Prohibition on Certain Referrals by Physicians and Limitations on Billing
-
411.354
Financial Relationship, Compensation, and Ownership or Investment Interest
-
411.355
General Exceptions to Referral Prohibitions Related to Both
Ownership/Investment and Compensation
-
411.356
Exceptions to Referral Prohibitions Related to Ownership or Investment
Interests
-
411.357
Exceptions to Referral Prohibitions Related to Compensation Arrangements
-
411.361 Reporting Requirements
Anti-Kickback Statutes and Regulations
The Anti-Kickback Statute 42
U.S.C. 1320a-7b
The Anti-Kickback Safe Harbors
Federal regulations at 42 C.F.R. 1001.952
Comparison Chart of Stark
Exceptions and Anti-Kickback Safe Harbors
Includes the Phase III revisions, effective December 4, 2007
They also include changes from the 2009 Inpatient Prospective Payment Final Rules published in Federal Register August 18, 2008
Related Resoures
Health Care False Claims Act Resource Center
A Bricker & Eckler resource center on the Federal False Claims Act with bulletins and other resources
The Health Care Reform Resource Center
A Bricker & Eckler resource center with bulletins, analysis and regulatory updates of various provisions of the law
Fraud Alerts
Collection of fraud alerts issued by the Office of the Inspector General of HHS
Special Advisory Bulletins
Collection of advisory bulletins issued by the Office of the Inspector General of HHS
Advisory Opinions
OIG advice on the application of the anti-kickback statute and other OIG sanction statutes in specific factual situations