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    Comparison Chart of Anti-Kickback Safe Harbors and Stark Exceptions -- Assistance to Compensate a Nonphysician Practitioner

    Assistance to Compensate a Nonphysician Practitioner – Current as of November 2017

    Stark
    Stark exception to the referral prohibition related to compensation arrangements for assistance to compensate a nonphysician practitioner This section was added effective January 1, 2016.  Click the link to see the full text.

    Anti-Kickback
    [No comparable safe harbor

    Remuneration provided by a hospital to a physician to compensate a nonphysician practitioner to provide patient care services.

     

    The arrangement is set out in writing and signed by the hospital, the physician, and the nonphysician practitioner.

     

    The arrangement is not conditioned on the physician's

     

    The remuneration from the hospital--

    (A) Does not exceed 50 percent of the actual compensation, signing bonus, and benefits paid by the physician to the nonphysician practitioner during a period not to exceed the first 2 consecutive years of the compensation arrangement between the nonphysician practitioner and the physician (or the physician organization in whose shoes the physician stands); and

    (B) Is not determined in a manner that takes into account (directly or indirectly) the volume or value of any actual or anticipated referrals by the physician (or any physician in the physician's practice) or other business generated between the parties; or the nonphysician practitioner (or any nonphysician practitioner in the physician's practice) or other business generated between the parties.

     

    The compensation, signing bonus, and benefits paid to the nonphysician practitioner by the physician does not exceed fair market value for the patient care services furnished by the nonphysician practitioner to patients of the physician's practice.

     

    The nonphysician practitioner has not, within 1 year of the commencement of his or her compensation arrangement with the physician (or the physician organization in whose shoes the physician stands) practiced in the geographic area served by the hospital; or been employed or otherwise engaged to provide patient care services by a physician or a physician organization that has a medical practice site located in the geographic area served by the hospital, regardless of whether the nonphysician practitioner furnished services at the medical practice site located in the geographic area served by the hospital.

     

    The nonphysician practitioner has a compensation arrangement with the physician or the physician organization in whose shoes the physician stands and substantially all of the services that the nonphysician practitioner furnishes to patients of the physician's practice are primary care services or mental health care services.

     

    The physician does not impose practice restrictions on the nonphysician practitioner that unreasonably restrict the nonphysician practitioner's ability to provide patient care services in the geographic area served by the hospital.

     

    The arrangement does not violate the Anti-Kickback statute, or any Federal or State law or regulation governing billing or claims submission.

     

    Records of the actual amount of remuneration provided by the hospital to the physician, and by the physician to the nonphysician practitioner, must be maintained for a period of at least 6 years and made available to the Secretary upon request.

     

    This exception may be used by a hospital, federally qualified health center, or rural health clinic only once every 3 years with respect to the same referring physician.

    This limitation does not apply to remuneration provided by a hospital, federally qualified health center, or rural health clinic to a physician to compensate a nonphysician practitioner to provide patient care services if the nonphysician practitioner is replacing a nonphysician practitioner who terminated his or her employment or contractual arrangement to provide patient care services with the physician (or the physician organization in whose shoes the physician stands) within 1 year of the commencement of the employment or contractual arrangement; and the remuneration provided to the physician is provided during a period that does not exceed 2 consecutive years as measured from the commencement of the compensation arrangement between the nonphysician practitioner who is being replaced and the physician (or the physician organization in whose shoes the physician stands).

     

    This exception applies to remuneration provided by a federally qualified health center or a rural health clinic in the same manner as it applies to remuneration provided by a hospital. The geographic area served by a federally qualified health center or a rural health clinic has the meaning as found in the physician recruitment exception.